Age-Related Changes in Pharyngeal Lumen Size: A Retrospective MRI Analysis

Abstract

Age-related loss of muscle bulk and strength (sarcopenia) is often cited as a potential mechanism underlying age-related changes in swallowing. Our goal was to explore this phenomenon in the pharynx, specifically, by measuring pharyngeal wall thickness and pharyngeal lumen area in a sample of young versus older women. MRI scans of the neck were retrospectively reviewed from 60 women equally stratified into three age groups (20s, 60s, 70+). Four de-identified slices were extracted per scan for randomized, blinded analysis: one mid-sagittal and three axial slices were selected at the anterior inferior border of C2 and C3, and at the pit of the vallecula. Pixel-based measures of pharyngeal wall thickness and pharyngeal lumen area were completed using ImageJ and then converted to metric units. Measures of pharyngeal wall thickness and pharyngeal lumen area were compared between age groups with one-way ANOVAs using Sidak adjustments for post-hoc pairwise comparisons. A significant main effect for age was observed across all variables whereby pharyngeal wall thickness decreased and pharyngeal lumen area increased with advancing age. Pairwise comparisons revealed significant differences between 20s versus 70+ for all variables and 20s versus 60s for all variables except those measured at C2. Effect sizes ranged from 0.54 to 1.34. Consistent with existing sacropenia literature, the pharyngeal muscles appear to atrophy with age and consequently, the size of the pharyngeal lumen increases.

Sarcopenia and dysphagia: Position paper by four professional organizations

“…Swallowing‐related muscles lose mass due to aging and disease, and a loss of muscle mass is associated with reduced swallowing function. Older populations show atrophy in the tongue, as shown by an ultrasound study atrophy in the geniohyoid muscle, as shown by a computed tomography study; and thinning in the pharyngeal wall, as shown by a magnetic resonance imaging study . Furthermore, ultrasound examinations in perioperative patients have shown atrophy in the geniohyoid muscle after surgery; the muscle atrophy of the geniohyoid muscle was significantly prominent in patients who could not recover to their preoperative level of oral intake within 2 weeks after surgery .…”

“…Older populations show atrophy in the tongue, as shown by an ultrasound study 36 atrophy in the geniohyoid muscle, as shown by a computed tomography study; 27 and thinning in the pharyngeal wall, as shown by a magnetic resonance imaging study. 37 Furthermore, ultrasound examinations in perioperative patients have shown atrophy in the geniohyoid muscle after surgery; the muscle atrophy of the geniohyoid muscle was significantly prominent in patients who could not recover to their preoperative level of oral intake within 2 weeks after surgery. 38 In acute stroke patients, computed tomography showed decreased muscle mass of the anterior belly of the digastric, geniohyoid and temporalis muscles at the time of hospitalization, which was related to dysphagia; additionally, muscle mass was more decreased with greater age.…”

The Impact of Aging and Progressive Neurological Disease on Swallowing: A Concise Overview

“…; Molfenter et al . ), and slower pharyngeal transit time (Cook et al . ), all of which can lead to the increased pharyngeal residue observed in elderly individuals (Ekberg and Feinberg ; Cook et al .…”

“…The increased pharyngeal lumen size observed in elderly individuals (Molfenter et al . ), could potentially lead to increased work load of the pharyngeal constrictors during swallow efforts. Research documenting a longer time to maximum pharyngeal constriction in the elderly (Tracy et al .…”

“…Similarly, age-related changes during the pharyngeal phase of swallowing include reduced tongue driving force and pharyngeal contractions (Dejaeger et al 1997;Kendall and Leonard 2001), reduced pharyngeal muscle thickness (Aminpour et al 2011;Molfenter et al 2015), and slower pharyngeal transit time (Cook et al 1994), all of which can lead to the increased pharyngeal residue observed in elderly individuals (Ekberg and Feinberg 1991;Cook et al 1994;Dejaeger et al 1997;Yoshikawa et al 2005). Additional age related changes include reduced laryngeal and hyoid elevation (Logemann et al 2000) and increased tendency for laryngeal penetration (Robbins et al 1999;Yoshikawa et al 2005;Rofes et al 2010).…”