PurposeThe aim of this study was to investigate improvements in swallowing function and physiology in a series of healthy older adults with radiographically confirmed dysphagia, following completion of an exercise-based swallowing intervention.Patients and methodsNine otherwise healthy older adults (six females, mean age =75.3, SD =5.3) had confirmed impairments in swallowing safety and/or efficiency on a modified barium swallow study. Each participant completed an 8-week swallowing treatment protocol including effortful swallows, Mendelsohn maneuvers, tongue-hold swallows, supraglottic swallows, Shaker exercises and effortful pitch glides. Treatment sessions were conducted once per week with additional daily home practice. Penetration–Aspiration Scale and the Modified Barium Swallowing Impairment Profile (MBSImP) were scored in a blind and randomized fashion to examine changes to swallowing function and physiology from baseline to post-treatment.ResultsThere were significant improvements in swallowing physiology as represented by improved oral and pharyngeal composite scores of the MBSImP. Specific components to demonstrate statistical improvement included initiation of the pharyngeal swallow, laryngeal elevation and pharyngeal residue. There was a nonsignificant reduction in median PAS scores.ConclusionSwallowing physiology can be improved using this standardized high-intensity exercise protocol in healthy adults with evidence of dysphagia. Future research is needed to examine the individual potential of each exercise in isolation and to determine ideal dose and frequency. Studies on various etiological groups are warranted.

Our findings support the notion that larger pharyngeal volumes (measured using acoustic pharyngometry) are associated with worse swallowing efficiency, a finding we attribute to atrophy of the pharyngeal musculature in healthy aging.

Previous research has established that a great deal of variation exists in the temporal sequence of swallowing events for healthy adults. Yet, the impact of aging on swallow event sequence is not well understood. Kendall et al. (Dysphagia 18(2):85-91, 2003) suggested there are 4 obligatory paired-event sequences in swallowing. We directly compared adherence to these sequences, as well as event latencies, and quantified the percentage of unique sequences in two samples of healthy adults: young (< 45) and old (> 65). The 8 swallowing events that contribute to the sequences were reliably identified from videofluoroscopy in a sample of 23 healthy seniors (10 male, mean age 74.7) and 20 healthy young adults (10 male, mean age 31.5) with no evidence of penetration-aspiration or post-swallow residue. Chi-square analyses compared the proportions of obligatory pairs and unique sequences by age group. Compared to the older subjects, younger subjects had significantly lower adherence to two obligatory sequences: Upper Esophageal Sphincter (UES) opening occurs before (or simultaneous with) the bolus arriving at the UES and UES maximum distention occurs before maximum pharyngeal constriction. The associated latencies were significantly different between age groups as well. Further, significantly fewer unique swallow sequences were observed in the older group (61%) compared with the young (82%) (χ = 31.8; p < 0.001). Our findings suggest that paired swallow event sequences may not be robust across the age continuum and that variation in swallow sequences appears to decrease with aging. These findings provide normative references for comparisons to older individuals with dysphagia.

ObjectivesEdema is a frequent clinical observation following chemoradiation treatment (CRT) of oral/oropharyngeal cancer and is thought to contribute to post‐CRT swallowing impairment. Our aims were to reliably quantify pharyngeal edema pre‐ and post‐CRT from videofluoroscopic (VF) swallowing studies and to explore the relationship between edema and swallowing impairment. Swallowing impairment was captured using patient‐reported swallowing outcomes (EAT‐10) and with VF confirmation of impairment (DIGEST).Methods40 patients (24 M, age 38–76) with oral/oropharyngeal cancer received radiotherapy (70 Gy, 7 weeks) and 3 weekly doses of cisplatin. VF and EAT‐10 were completed pre‐ and 1‐month post‐CRT. Edema was captured by measuring posterior pharyngeal wall (PPW) thickness, vallecular space, and pharyngeal area (PA) on a single post‐swallow rest frame. Wilcoxon sign rank tests and paired t‐tests evaluated within‐subject changes in impairment and edema respectively. A linear mixed effect regression model explored the influence of time, patient‐reported outcomes, and functional impairment on measures of edema.ResultsSwallowing function (EAT‐10 and DIGEST) was significantly worse post‐CRT. PPW thickness (but not vallecular space and pharyngeal area) was significantly worse post‐CRT. PPW thickness was only significantly influenced by time (pre‐ vs. post‐CRT) but not by measures of swallow function.ConclusionOur findings establish the use of PPW thickness as a reliable measure of acute edema in post‐CRT treatment. In this small, retrospective sample, edema was not significantly correlated with either patient‐reported or measured swallow function. Prospective longitudinal work, examining the relationship between objective measures of edema, patient perception of impairment, and swallow function and biomechanics is warranted.Level of Evidence4.

Purpose Previous work has established that advanced bolus location at swallow onset (BLSO) alone is not correlated with an increased swallowing safety risk in healthy seniors. The primary goal of this retrospective study was to examine whether healthy seniors systematically alter their laryngeal vestibule closure reaction time (LVCrt) to maintain a safe swallow in the context of advanced BLSO. The secondary goal was to determine if longer LVCrt distinguished Penetration–Aspiration Scale (PAS; Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996) scores of 1 versus 2. Method Videofluoroscopy studies from 43 healthy seniors (21 men, 22 women; M age = 76.7 years, SD = 7.2) were analyzed. LVCrt was calculated for 3 × 5 ml and 3 × 20 ml thin liquid barium boluses per participant. PAS and BLSO (Modified Barium Swallow Impairment Profile Component 6) were scored for all swallows. Reliability (intraclass correlation coefficient > .75) was established on all measures. A linear mixed-effects regression was run to examine the effect of PAS and BLSO on LVCrt while controlling for bolus volume and repeated swallow trial. Results There was a main effect of BLSO ( F = 4.6, p = .004) and PAS ( F = 29.3, p < .001) on LVCrt. Post hoc pairwise comparisons revealed that LVCrt was significantly faster in BLSO scores of 3 (pyriforms) compared to scores of both 0 (posterior angle of the ramus) and 1 (valleculae). Significantly prolonged LVCrt was observed in PAS scores of 2 in comparison to 1. No significant main effects of bolus volume or trial, or interactions, were observed. Conclusions Our findings suggest that healthy seniors compensate for advanced BLSO by increasing their LVCrt. Furthermore, faster LVCrt was shown to distinguish PAS scores of 1 versus 2. Additional work should explore the relationship between LVCrt, BLSO, and PAS scores in dysphagic populations, specifically those with known sensory impairments.