A Preliminary Investigation of Similarities of High Resolution Cervical Auscultation Signals Between Thin Liquid Barium and Water Swallows

Abstract

Dysphagia, commonly referred to as abnormal swallowing, affects millions of people annually. If not diagnosed expeditiously, dysphagia can lead to more severe complications, such as pneumonia, nutritional deficiency, and dehydration. Bedside screening is the first step of dysphagia characterization and is usually based on pass/fail tests in which a nurse observes the patient performing water swallows to look for dysphagia overt signs such as coughing. Though quick and convenient, bedside screening only provides low-level judgment of impairment, lacks standardization, and suffers from subjectivity. Recently, high resolution cervical auscultation (HRCA) has been investigated as a less expensive and non-invasive method to diagnose dysphagia. It has shown strong preliminary evidence of its effectiveness in penetration-aspiration detection as well as multiple swallow kinematics. HRCA signals have traditionally been collected and investigated in conjunction with videofluoroscopy exams which are performed using barium boluses including thin liquid. An HRCA-based bedside screening is highly desirable to expedite the initial dysphagia diagnosis and overcome all the drawbacks of the current pass/fail screening tests. However, all research conducted for using HRCA in dysphagia is based on thin liquid barium boluses and thus not guaranteed to provide valid results for water boluses used in bedside screening. If HRCA signals show no significant differences between water and thin liquid barium boluses, then the same algorithms developed on thin liquid barium boluses used in diagnostic imaging studies, it can be then directly used with water boluses. This study investigates the similarities and differences between HRCA signals from thin liquid barium swallows compared to those signals from water swallows. Multiple features from the time, frequency, time-frequency, and information-theoretic domain were extracted from each type of swallow and a group of linear mixed models was tested to determine the significance of differences. Machine learning classifiers were fit to the data as well to determine if the swallowed material (thin liquid barium or water) can be correctly predicted from an unlabeled set of HRCA signals. The results demonstrated that there is no systematic difference between the HRCA signals of thin liquid barium swallows and water swallows. While no systematic difference was discovered, the evidence of complete conformity between HRCA signals of both materials was inconclusive. These results must be validated further to confirm conformity between the HRCA signals of thin liquid barium swallows and water swallows.

Non-Invasive Sensor-Based Estimation of Anterior-Posterior Upper Esophageal Sphincter Opening Maximal Distension

“…VFSS videos were segmented into individual swallow segments by tracking the bolus to determine the onset and offset of pharyngeal swallowing. The onset of the swallow was defined as the frame in which the bolus head passed the ramus of the mandible, and the offset of the swallow was defined as the frame in which the hyoid bone returned to its lowest resting position after clearance of the bolus tail through the UES [15] , [24] , [25] . The time of UES opening and closure were determined for each swallow in the segmented videos.…”

Advancements and Challenges in Non-Invasive Sensor Technologies for Swallowing Assessment: A Review

“…Therefore, many research teams have considered using HECA as a screening tool to evaluate the opening and closing of the upper esophageal sphincter, analyze the similarities between thin liquid barium and water during swallowing, study the relationship with hyoid displacement during swallowing, and detect aspiration [124][125][126][127].…”

A review on intelligent aid diagnosis for dysphagia using swallowing sounds

“…Considering the swallowing motion trajectory and its anatomic location variations, some studies have acquired swallowing signals at the suprasternal notch 24,25 . However, the majority of signal acquisitions utilized sensors positioned around the cricoid cartilage of the neck [26][27][28][29][30][31][32][33][34][35][36] . Takahashi et al 37 conducted the first comprehensive study of collection sites and found that the optimal detection site (site 1) was located at the lower edge of the cricoid cartilage, bilaterally in the trachea.…”