Altered pharyngeal structure and dynamics among patients with cervical kyphosis

Randall, Derrick R.; Strong, E. Brandon; Belafsky, Peter C.

doi:10.1002/lary.26417

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…PCR is defined as the ratio of the pharyngeal area measured in the lateral view at the point of maximum pharyngeal constriction to the area measured with a 1‐mL bolus held in the oral cavity and is a validated measure of pharyngeal contractility. An elevated PCR suggests diminished pharyngeal strength 21,22 …”

Section: Methodsmentioning

confidence: 99%

Cervical Fibrosis as a Predictor of Dysphagia

et al. 2020

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Objective Radiotherapy of head and neck cancer (HNCA) causes dysfunction through radiation‐induced fibrosis (RIF). We hypothesize that the degree of cervical fibrosis is associated with swallowing dysfunction. This study evaluated the association between cervical fibrosis and swallowing dysfunction in patients after radiation therapy for HNCA. Study Design Cross sectional study. Methodology A convenience sample of patients with dysphagia who were at least 1 year post radiation therapy for HNCA underwent simultaneous cervical ultrasound (US) and video‐fluroscopic swallow study (VFSS). US determinants of fibrosis were measurements of sternocleidomastoid fascia (SCMF) thickness bilaterally at the level of the cricoid. Primary and secondary outcome variables on VFSS were pharyngeal constriction ratio, a validated measure of pharyngeal contractility, and penetration aspiration scale (PAS). A qualitative assessment of lateral neck rotation was performed as a functional measure of neck fibrosis. Results Simultaneous cervical US and VFSS examinations were performed on 18 patients with a history of radiotherapy for HNCA and on eight controls. The mean (±SD) age of the entire cohort (N = 26) was 66 (±10) years. Individuals with a history of radiation had significantly thinner mean SCMF (0.26 [±0.04 mm]) compared to controls (0.48 [±0.06 mm]; P < .05). Individuals with thinner SCMF were more likely to have moderate to severe restriction in lateral neck rotation, a higher PCR, and a higher PAS (P < .05). Conclusion Thinner sternocleidomastoid fascia on ultrasound in patients having undergone radiotherapy for head and neck cancer was associated with reduced lateral neck movement, poorer pharyngeal constriction and greater penetration/aspiration scale. The data suggest that cervical fibrosis is associated with swallowing dysfunction in head and neck cancer survivors and support the notion that, “As the neck goes, so does the swallow.” Level of Evidence 3. Laryngoscope, 131:548–552, 2021

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Section: Methodsmentioning

confidence: 99%

Cervical Fibrosis as a Predictor of Dysphagia

et al. 2020

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“…[ 13 15 ] A retrospective analysis of data from video fluoroscopic swallow studies of 36 patients with cervical kyphosis confirmed the association between cervical kyphosis and altered pharyngeal structure and swallowing dysfunction. [ 16 ] The study revealed that patients with cervical kyphosis have a significantly dilated pharynx, elongated hypopharyngeal transit time, and worsened penetration–aspiration scores (the depth to which food passes in the airway). [ 16 ] Other retrospective studies[ 17 18 ] in patients treated with an external immobilization of the cervical spine (wearing a Halo-vest) showed significant association with the incidence of dysphagia, ranging from 32 to 66%.…”

Section: Discussionmentioning

confidence: 99%

“…[ 16 ] The study revealed that patients with cervical kyphosis have a significantly dilated pharynx, elongated hypopharyngeal transit time, and worsened penetration–aspiration scores (the depth to which food passes in the airway). [ 16 ] Other retrospective studies[ 17 18 ] in patients treated with an external immobilization of the cervical spine (wearing a Halo-vest) showed significant association with the incidence of dysphagia, ranging from 32 to 66%. Miyagi et al .…”

Section: Discussionmentioning

confidence: 99%

Cervicogenic dysphagia associated with cervical spondylosis

Chu

Lee

2021

Journal of Family Medicine and Primary Care

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Dysphagia (swallowing difficulty) is most often related to another health problems, including brain or spinal cord injury, neurological damage, neuromuscular disorders, and anatomical conditions. Dysphagia can have detrimental effects on pulmonary health and also impact nutritional intake. The right treatment depends on the cause established. Cervicogenic dysphagia is a cervical cause of difficulty in swallowing. This report describes a 53-year-old female patient with sore throat, swallowing difficulty for solids, and acid reflux for 2 years. Radiographs revealed anterior osteophytic lipping and kyphosis of the cervical spine and thoracolumbar (right convex) scoliosis. After 6 months of chiropractic treatment, her complaints and spinal deformity were obviously resolved. Our case report is unique in that the patient had an unusual presentation, i.e. cervical osteophytes, cervical kyphosis, and thoracolumbar scoliosis, which are all contributable causes of dysphagia. Correction of spinal deformity could result in positive treatment outcomes in selected patients with symptoms of cervicogenic dysphagia.

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“…Review of the literature and personal consultation with a specialist in otolaryngology indicates that there is no consensus regarding a protocol for performing VFSS in people with dysphagia (personal communication with Peter Belafsky MD, PhD, Medical Director of the Voice and Swallowing Center University of California, Davis). Unalike protocols are reported by different institutions in the United States currently publishing in this area of research (23–25) although protocol consensus may be consistent loco-regionally or in different countries. The method for assessment of VFSS studies is also not standardized in people despite the fact that a comprehensive set of quantitative measures have been developed, reported and validated (26).…”

Section: Discussionmentioning

confidence: 99%

Videofluoroscopic Evaluation of the Pharynx and Upper Esophageal Sphincter in the Dog: A Systematic Review of the Literature

Pollard

2019

Front. Vet. Sci.

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Background: Diseases of the pharynx and upper esophageal sphincter can result in debilitating respiratory difficulty, dysphagia or a combination of both. An exact diagnosis is essential to properly prognosticate and guide therapy. Videofluoroscopic assessment of the pharynx and upper esophageal sphincter with or without orally administered contrast material is the diagnostic of choice for many diseases as both anatomic and functional information is gleaned. The purpose of this review is to assess for continuity in imaging protocols across institutions and to record quantitative and qualitative parameters used for analysis of videofluoroscopy of the pharynx and upper esophageal sphincter in dogs. Methods: A systematic literature search was performed including articles published in peer-reviewed veterinary journals involving the topic of videofluoroscopy of the pharynx and upper esophageal sphincter through August 1, 2018. Specifics of study acquisition technique were recorded. Quantitative and qualitative videofluoroscopic parameters were recorded and compared across institutions where appropriate using one-way ANOVA with p ≤ 0.05 being considered significant. Results: Videofluoroscopy of the pharynx and upper esophageal sphincter is performed either in right lateral or standing postures depending on the institution. Bolus size and consistency used during contrast videofluoroscopy of swallowing differs between institutions. Some institutions evaluate videofluoroscopic studies using qualitative criteria while others apply quantitative measures. Reported quantitative measures include inter-swallow interval, swallow rate, jaw cycles per swallow ratio, time to upper esophageal opening, maximal pharyngeal contraction, maximum laryngeal excursion, upper esophageal closure, epiglottic re-opening, and pharyngeal constriction ratio. Measurement outcomes are significantly different between institutions and when bolus size/consistency is variable when assessing healthy dogs. Conclusions: The current peer-reviewed literature on fluoroscopic evaluation of the pharynx and UES in dogs shows a lack of standardization regarding imaging protocol. There is not a standard set of quantitative criteria applied amongst the institutions and there are significant differences in the outcomes obtained from videofluoroscopic assessment of swallowing suggesting significant inter-observer or inter-institutional variability. A consensus statement regarding imaging protocol and what parameters should be used to interpret airway and swallowing videofluoroscopic studies of the pharynx and UES in dogs is needed along with targeted analysis of observer variability.

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Altered pharyngeal structure and dynamics among patients with cervical kyphosis

Abstract: 3b. Laryngoscope, 127:1832-1837, 2017.

Cited by 8 publications

References 24 publications

Cervical Fibrosis as a Predictor of Dysphagia

Cervical Fibrosis as a Predictor of Dysphagia

Cervicogenic dysphagia associated with cervical spondylosis

Videofluoroscopic Evaluation of the Pharynx and Upper Esophageal Sphincter in the Dog: A Systematic Review of the Literature

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