Sarcopenic dysphagia is a significant concern in head and neck cancer (HNC) patients and contributes to malnutrition, aspiration pneumonia and poor clinical outcomes. Although tongue strength (TS) and swallowing muscle mass (SwMM) are central components of swallowing physiology, their relationship in HNC patients remains unclear. This study investigated the association between SwMM and TS and tongue endurance in HNC patients. This prospective cross-sectional study was conducted at the University Medical Center Groningen between February 2023 and April 2025. Fifty-three patients with primary mucosal HNC were included before treatment. SwMM was quantified on contrast-enhanced CT scans using the mid-sagittal tongue complex muscle (TCM) area as a proxy for SwMM volume. TS and tongue endurance were measured with the Iowa Oral Performance Instrument. Associations were evaluated using Pearson and Spearman correlation analyses and univariable and multivariable linear regression adjusted for age, sex, and nutritional status. SwMM was not significantly correlated with maximum TS at the anterior or posterior positions (r = 0.080 and r = 0.048, respectively; both p > 0.05), nor with tongue endurance (r= − 0.043 and r= − 0.004, respectively; both p > 0.05). Regression analyses confirmed that SwMM was not significantly associated with tongue performance, including in adjusted multivariable models. SwMM and tongue muscle performance represent distinct physiological domains in untreated HNC patients. The mid-sagittal TCM area, as a proxy for SwMM, was not associated with tongue pressure capacity, suggesting that TS alone may overlook lower SwMM. CT-based SwMM assessment is feasible but should complement functional assessments for a comprehensive evaluation of sarcopenic dysphagia.
There is no consensus regarding the effect of potassium on swallowing initiation. In this study, we evaluated how the topical infusion of several solutions, including potassium chloride (KCl), affects involuntary swallowing initiation in humans. Hypopharyngeal fluid stimulation was an infusion of saline (154 mM sodium chloride), 154 mM KCl, and distilled water (DW) at two infusion rates (0.2 mL/min and 3.0 mL/min) for 1 min administered to 27 volunteers. Participants were instructed to swallow when ready. Electromyography (EMGs) of the suprahyoid muscles was performed to determine swallowing muscle activity. At a lower infusion rate (0.2 mL/min), the difference in the number of swallows and the time interval between two consecutive swallows were observed only between saline and DW and between saline and KCl. At a higher rate (3.0 mL/min), a difference was observed between DW and KCl; the order of facilitatory effects was KCl, DW, and saline. The area and duration, especially the peak-to-offset time, of the EMG bursts were significantly larger and longer, respectively, during voluntary swallowing than during involuntary swallowing under all conditions. Considering the differences in the effects of KCl on swallowing initiation between previous studies and ours, some methodological differences should be considered, such as infusion rate or site and the effect of taste stimulation on the central neural network. In conclusion, KCl application at lower infusion rates is not sufficient to enhance swallowing initiation beyond that evoked by water stimulation, whereas at a higher infusion rate (3.0 mL/min), it facilitates swallowing initiation via combined ionic, chemosensory, mechanical, and/or other sensory inputs.
Inspiratory muscle training (IMT) has been discussed in the context of swallowing rehabilitation, yet its neuromuscular characteristics relative to established swallowing exercises remain unclear. This study aimed to compare profiles of muscle activation amplitude during IMT and the Shaker exercise, with a focus on task-specific recruitment of the suprahyoid, cervical, and respiratory muscles. In a single-center, prospective crossover study, healthy young adults performed IMT using a flow-resistive device and the Shaker exercise in randomized order. Surface electromyography (sEMG) was recorded from the anterior digastric, sternocleidomastoid, trapezius, and diaphragm-related respiratory muscles. sEMG amplitudes were normalized to maximal voluntary contraction (
The sensory function of the tongue is crucial for chewing and swallowing. A decline in this function due to aging or disability increases the risk of aspiration, choking, and aspiration pneumonia. The objective of this study was to determine whether stochastic resonance, in which the application of noise vibrations enhances the tactile sensitivity of fingers and other body parts, also occurs in the tongue and to determine its effects. To do so, we evaluated the effects of noise vibration applied to the submental region on tongue sensitivity during both passive and active touch. This was assessed in 15 young men (mean age ± standard deviation, 22.7 ± 1.0 years) and 12 older men (73.9 ± 5.2 years) with no tongue-related disorders or relevant medical history. The Semmes–Weinstein perception test was used to measure tactile thresholds, while the Roughness Discrimination Test was used to assess the accuracy rates of roughness discrimination. The tactile threshold for passive touch decreased in 96
This randomized controlled trial evaluated the efficacy of home-based treatment programs for chronic radiation associated dysphagia (CRAD) in head and neck cancer (HNC) patients, comparing high-volume strength training to combined strength-skill training with either real or sham High-Definition transcranial Direct Current Stimulation (HD-tDCS). 54 HNC survivors with CRAD were randomized in 3 groups, each performing exercises 4 times per week over 8 weeks. Group 1 (n = 18) received strength training only, consisting of tongue strengthening exercises, chin tuck against resistance exercises with effortful swallowing and expiratory muscle strength training. Group 2 (n = 18) completed the same regimen for 4 weeks, followed by 4 weeks of skill training according to the McNeill Dysphagia Therapy Program. Group 3 (n = 18) completed this combined therapy program while receiving HD-tDCS over the swallowing motor cortex during each therapy session. To examine the additional effect of HD-tDCS, group 2 received sham stimulation. All groups showed significant improvements in functional oral intake (p < .001), swallowing function (p < .05) and muscle strength (p < .001). Participants receiving combined strength and skill training (group 2 + 3) had significantly greater odds of better oral intake outcomes after 8 weeks of training (OR 13.47, 95
Swallowing rehabilitative therapies are widely used to manage impairments in head and neck cancer (HNC), but their pooled effects outcomes have not been established. This study aimed to evaluate the effects of swallowing rehabilitative therapies on functional outcomes and quality of life (QoL) in HNC patients. We searched six databases from inception through December 2024, with no restrictions on date, region, or language. Only randomized controlled trials (RCTs) were eligible. Functional outcomes comprised swallowing function, aspiration/penetration, oral intake, mouth opening, and pain, whereas QoL was assessed overall and across its domains. Pooled effect sizes were estimated using Hedges’ g with 95
Duchenne muscular dystrophy (DMD) is associated with progressive dysphagia. Although histopathological changes in the masseter and tongue muscles have been reported in DMD rats, little is known regarding swallowing-related muscles, especially those involved in the pharyngeal phase. Therefore, this study evaluated the swallowing function and pathology of swallowing-related muscles in a DMD rat model. Seven male DMD rats and five wild-type (WT) rats were used. Their body weight and food intake amount were monitored weekly. Electromyography (EMG) was performed on the geniohyoid muscle to assess the compound muscle action potential (CMAP) amplitude, swallow frequency, and swallowing duration. It was conducted at 90 weeks in WT rats and at the time point of 10
Evidence on electrical stimulation for post‑stroke dysphagia (PSD) remains inconsistent. This meta‑analysis evaluated the efficacy of neuromuscular electrical stimulation (NMES), transcranial direct current stimulation (tDCS), and peripheral electrical stimulation (PES).Randomized controlled trials (RCTs) investigating electrical stimulation therapy for patients with post-stroke dysphagia were searched in PubMed, Embase, and the Cochrane Library from inception to December 12, 2024. The primary outcomes were the Functional Oral Intake Scale (FOIS), Dysphagia Outcome and Severity Scale (DOSS), Penetration-Aspiration Scale (PAS), and Standardized Swallowing Assessment (SSA). Secondary outcomes included pharyngeal transit time (PTT), oral transit time (OTT), and surface electromyography (sEMG) signals of swallowing muscles. Meta-analysis was performed by pooling the Mean Difference (MD) with 95
Cervical auscultation (CA), used an adjuvant to the clinical feeding examination by Speech-Language Pathologists (SLPs), has high sensitivity and reliability for detecting aspiration in neonates and children. CA can only be considered reliable if there are clear distinctions in the acoustic and perceptual swallow sound profiles between swallow sounds associated with and without aspiration. We aimed to determine whether the acoustic and perceptual swallow sound profile differs between swallows associated with and without aspiration in preterm neonates. We simultaneously recorded video and swallow sounds during videofluoroscopic swallow studies. We used the Penetration-Aspiration Scale to define aspiration. Acoustic parameters were obtained using a Python program. Two SLPs independently rated the presence/absence of perceptual parameters from 1 s audio wavefiles. Differences between swallow types were analyzed using mixed linear regression modelling to account for clustered data, and a test of two proportions for acoustic and perceptual parameters, respectively. Penalized logistic regression analysis was used for perceptual sound predictors of aspiration. A total of 293 swallows (7 aspiration, 286 no aspiration) from 13 preterm neonates [69
There is international uncertainty and little guidance regarding oral feeding on nasal continuous positive airway pressure (nCPAP) and high-flow nasal cannula (HFNC) respiratory support. The aim of this study is to investigate current practice in the UK when deciding to offer oral feeds to infants on nCPAP/HFNC. A novel survey was designed and conducted using Qualtrics. Purposive sampling was used to recruit participants in speech and language therapy, medicine and nursing via professional associations. Participants completed the 41-item survey which explored oral feeding practices for infants on nCPAP/HFNC. The survey included closed-choice and open-ended questions. Descriptive statistics using SPSS, were used to analyse quantitative findings. A frequency count and thematic analysis were used to describe qualitative data. 103 responses were analysed. Regarding frequency of oral feeding on nCPAP, most respondents (45
An older woman in her late 70s was referred for swallowing assessment because of recurrent aspiration pneumonia, weight loss, low body mass index, reduced handgrip strength, and slow gait speed, initially suggesting sarcopenic dysphagia. However, flexible endoscopic evaluation of swallowing and videofluoroscopic swallowing study demonstrated marked delay in swallow initiation, impaired airway protective reflexes, and reduced pharyngeal sensation despite the absence of substantial pharyngeal residue and relatively preserved upper esophageal sphincter opening. Careful reassessment of the videofluoroscopic study revealed abnormal craniovertebral alignment. Subsequent computed tomography demonstrated atlantoaxial dislocation with superior migration of the odontoid process, and magnetic resonance imaging confirmed compression of the medulla oblongata. This case highlights the importance of avoiding oversimplified attribution of dysphagia to sarcopenia and of reconsidering alternative neural or structural mechanisms when observed swallowing physiology is discordant with the presumed diagnosis.
Swallowing activities have been increasingly recognized as relevant to cognitive function, yet the physiological pathways linking these functions to the brain remain incompletely understood. One proposed mechanism involves changes in cerebral blood flow. This study examined whether a standardized oral exercise program could alter prefrontal cerebral blood flow, measured by near-infrared spectroscopy. This single-center prospective study enrolled 52 healthy adults (mean age 33.1 ± 10.4 years; 67.3
The aim of this pilot study was to develop and administer a novel parent-report metric, the EZ-chEW, for documenting the temporal characteristics of jaw performance during chewing across various consistencies. We hypothesized that parents could collect data in their home environment and that toddlers would exhibit age- and consistency-related characteristics consistent with prior kinematic research. The development of the EZ-chEW questionnaire was informed by a review of the literature on chewing development, focusing on temporal aspects of chewing. Full-term children participated in chewing trials at 12, 18, 24, and 30 months. Parents reported on three trials per timepoint, and data were categorized into consistency groups using consensus scoring. Sixty-seven toddlers participated longitudinally. Parents completed home data collection with minimal instruction and no direct assistance. Chewing duration (seconds) and the number of cycles (i.e., mandibular open/close cycles) varied by age (p = .001 and p = .035, respectively) and by food consistency (both p < .001), with more complex consistencies generally requiring longer chewing durations and more chewing cycles across all ages. Chewing efficiency (cycles/sec) remained relatively stable across ages (p = .238) but differed by consistency, with more complex foods resulting in higher cycles/sec values p = .028). Parental assessment of chewing performance offers a valuable supplement to clinical evaluations of oromotor function. By capturing naturalistic behaviors in a home setting, EZ-chEW reduces the burden on healthcare providers and families while providing insights into chewing performance. These findings highlight the potential of EZ-chEW as an accessible tool for guiding interventions tailored to the needs of toddlers and their families.
Existing scales for the detection of penetration and aspiration of material into the airway do not reliably predict pulmonary outcomes like pneumonia. We present here the development and validation of methods to track the short-term and long-term effects of aspiration on the appearance of the lungs in an infant pig model. Six pigs that varied in frequency and severity of aspiration were recorded as they fed on barium milk over two weeks (from 1 to 9 months human equivalent), capturing the entire airway in high-speed videofluoroscopic recordings (125 fps). Dorsoventral views of the lungs were used to collect minimum and mean greyscale measurements in relation to two phenomena: (1) liquid infiltration in the lungs during a feed and (2) liquid accumulation in the lungs due to repeated aspiration and development of inflammation over several days. Measurements were reliable within and across four raters (intra- and inter-rater ICC ≥ 0.67). We measured the darkening of the lungs due to the infiltration of liquid (paired t-test, p ≤ 0.016) and the accumulation of liquid over five days (p ≤ 0.001). Lastly, we compared the lung greyscale of all six pigs to their swallow safety scores (Infant Mammalian Penetration Aspiration Scale). Worsened lung greyscale was weakly correlated with high frequency of aspiration (Pearson’s correlation coefficient − 0.16 to -0.21), indicating other factors play a role in the development of negative health outcomes following aspiration. Using these techniques, future longitudinal studies in the infant pig model may shed light on the links between airway protection and lung health.
Racial and ethnic disparities in healthcare access, utilization, and quality are well-documented, but have been largely unexplored for individuals with oropharyngeal dysphagia. We conducted a scoping review to (1) describe methods used to assess disparities in oropharyngeal dysphagia care, (2) summarize study findings, and (3) make recommendations for future research based on literature gaps. We searched MEDLINE (Ovid), Embase, APA PsycInfo, and CINAHL (January 1990-December 2024) for original experimental or observational studies evaluating associations between race and/or ethnicity and access to, utilization, or quality of oropharyngeal dysphagia care. Two reviewers completed title/abstract screening and full-text review. We extracted study metadata, methods, and results and synthesized findings quantitatively and narratively. We retrieved 3,201 records; after deduplication, 2,498 underwent title/abstract screening, 61 full-text review, and 9 were included. Studies varied substantially in definitions of dysphagia care, operationalization of race/ethnicity, data sources, and analytic approaches. Importantly, no studies examined disparities in access to care or quality of care. A key methodological finding was that results differed systematically by whether analyses accounted for clinical need: analyses controlling for proxies of need more often found lower utilization among Black patients (or no differences), whereas analyses without need adjustment more often reported similar or higher utilization among racially and ethnically minoritized groups. These findings underscore the need for more methodologically rigorous research on disparities across the dysphagia care continuum. We propose a framework to guide future studies and recommendations to improve measurement of care, race/ethnicity, and clinical need.
In this study, we investigating the comparative efficacy of training intensity in terms of adherence and patient-reported outcomes. Specifically, we aimed to establish the optimal balance between training intensity and adherence to a modified (low-intensity) expiratory muscle strength training (EMST) protocol in degenerative parkinsonism. No randomized controlled trial has been conducted to evaluated the efficacy of such a modified EMST protocol compared with the conventional protocol to date. Thirty participants were randomly assigned to high- and low-intensity groups and completed a 6-week EMST program. The high-intensity group demonstrated significant improvements in respiratory function, measured as the maximal expiratory pressure (MEP) and peak cough flow, and in swallowing function, assessed via the penetration-aspiration scale and the Normalized Residue Ratio Scale (NRRS) for the vallecular spaces. The low-intensity group showed significant improvements in swallowing function measures only. Correlation analyses revealed that, in the high-intensity group, improvements in the maximal inspiratory pressure were significantly associated with improvements in swallowing function, while improvements in the MEP were significantly correlated with reductions in the NRRS (vallecular) score. Quality of life related to swallowing, measured using the Korean version of the Swallowing Quality of Life questionnaire total score, improved significantly in both groups. Taken together, high-intensity EMST resulted in broader improvements across respiratory and swallowing function, while the groups demonstrated comparable improvements in swallowing-related quality of life. Therefore, although high-intensity EMST may provide more comprehensive benefits, adapting the training intensity based on patient tolerance and adherence may render low-intensity protocols a reasonable alternative for selected patients.
