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Objectives/Hypothesis
Determine swallowing mechanics associated with the first and second epiglottic movements, that is, movement to horizontal and full inversion, respectively, to provide a clinical interpretation of impaired epiglottic function.
The Laryngoscope
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Laryngology
Computational analysis of swallowing mechanics underlying impaired epiglottic inversion
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Presented at the 31st Annual Meeting of the American Association of Clinical Anatomists, Orlando, Florida, U.S.A., July 8–12, 2014.
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Videofluoroscopic and modified barium swallow impairment profile epiglottic component score data were collected at Medical University of South Carolina; imaging and computational analysis were performed at the Medical College of Georgia, Augusta, Georgia. b.m.-h. established the modified barium swallow impairment profile (MBSImP). b.m.-h. trains other speech–language pathologists in the use of this methodology, supported by Northern Speech Services, Gaylord, Michigan.
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The 2014 Sushruta-Guha Award in Clinical Anatomy provided by the American Association of Clinical Anatomists supported the dissemination of this study. Imaging data included in this study were acquired through the following grants from NIH National Institute on Deafness and Other Communication Disorders 1K24DC12801 (principal investigator: b.m.-h.).
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The authors have no other funding, financial relationships, or conflicts of interest to disclose.
Abstract
Study Design
Retrospective cohort study.
Methods
A heterogeneous cohort of patients with swallowing difficulties was identified (n = 92). Two speech-language pathologists reviewed 5-mL thin and 5-mL pudding videofluoroscopic swallow studies per subject, and assigned epiglottic component scores of 0 = complete inversion, 1 = partial inversion, and 2 = no inversion, forming three groups of videos for comparison. Coordinates mapping minimum and maximum excursion of the hyoid, pharynx, larynx, and tongue base during pharyngeal swallowing were recorded using ImageJ software. A canonical variate analysis with post hoc discriminant function analysis of coordinates was performed using MorphoJ software to evaluate mechanical differences between groups. Eigenvectors characterizing swallowing mechanics underlying impaired epiglottic movements were visualized.
Results
Nineteen of 184 video swallows were rejected for poor quality (n = 165). A Goodman-Kruskal index of predictive association showed no correlation between epiglottic component scores and etiologies of dysphagia (λ = .04). A two-way analysis of variance by epiglottic component scores showed no significant interaction effects between sex and age (f = 1.4, P = .25). Discriminant function analysis demonstrated statistically significant mechanical differences between epiglottic component scores: 1 and 2, representing the first epiglottic movement (Mahalanobis distance = 1.13, P = .0007); and 0 and 1, representing the second epiglottic movement (Mahalanobis distance = 0.83, P = .003). Eigenvectors indicate that laryngeal elevation and tongue base retraction underlie both epiglottic movements.
Conclusions
Results suggest that reduced tongue base retraction and laryngeal elevation underlie impaired first and second epiglottic movements. The styloglossus, hyoglossus, and long pharyngeal muscles are implicated as targets for rehabilitation in dysphagic patients with impaired epiglottic inversion.
Level of Evidence
2b Laryngoscope, 126:1854–1858, 2016