Anterior–posterior distension of maximal upper esophageal sphincter opening is correlated with high-resolution cervical auscultation signal features

Abstract

Objective. Adequate upper esophageal sphincter (UES) opening is essential during swallowing to enable clearance of material into the digestive system, and videofluoroscopy (VF) is the most commonly deployed instrumental examination for assessment of UES opening. High-resolution cervical auscultation (HRCA) has been shown to be an effective, portable and cost-efficient screening tool for dysphagia with strong capabilities in non-invasively and accurately approximating manual measurements of VF images. In this study, we aimed to examine whether the HRCA signals are correlated to the manually measured anterior–posterior (AP) distension of maximal UES opening from VF recordings, under the hypothesis that they would be strongly associated. Approach. We developed a standardized method to spatially measure the AP distension of maximal UES opening in 203 swallows VF recording from 27 patients referred for VF due to suspected dysphagia. Statistical analysis was conducted to compare the manually measured AP distension of maximal UES opening from lateral plane VF images and features extracted from two sets of HRCA signal segments: whole swallow segments and segments excluding all events other than the duration of UES is opening. Main results. HRCA signal features were significantly associated with the normalized AP distension of the maximal UES opening in the longer whole swallowing segments and the association became much stronger when analysis was performed solely during the duration of UES opening. Significance. This preliminary feasibility study demonstrated the potential value of HRCA signals features in approximating the objective measurements of maximal UES AP distension and paves the way of developing HRCA to non-invasively and accurately predict human spatial measurement of VF kinematic events.

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

“…The UES maximal distension usually happens at, shortly before or shortly after the frame of the maximal hyoid bone displacement, so judges measured the UES distension at the frame of the maximal hyoid bone displacement, 2-3 frames before and 2-3 frames after (5-7 frames in total). The A-P maximal distension was calculated using all measured frames [7] , [21] , [26] . Judges measured selected frames using a protocol and a software developed in our lab [21] .…”

“…The A-P maximal distension was calculated using all measured frames [7] , [21] , [26] . Judges measured selected frames using a protocol and a software developed in our lab [21] . The protocol was as follows: The height of the third vertebral unit (C3) was used to standardize the location of the superior and inferior limits of the UES.…”

“…HRCA has not only been effective in the temporal localization of swallow kinematic events, but also in performing spatial swallow measurements such as tracking hyoid bone displacement with high accuracy as compared to measurements by expert judges on VFSS [19] , [20] . Further, strong associations exist between HRCA signals and other swallow spatial measurements such as the anterior-posterior (A-P) UES opening maximal distension [21] . Using HRCA to quantitatively measure the A-P UES opening maximal distension has not yet been addressed or implemented.…”

Temporal Sequence of Laryngeal Vestibule Closure and Reopening is Associated With Airway Protection

“…The timing measurements of UESO and LVC were marked for each swallow according to the following criteria: UESO onset : The time of the first frame in which air or barium contrast is observed in the UES region 28 UESO offset : The time of the first frame in which air or barium contrast is completely cleared from the UES region 27 LVC : The time of the first frame in which air space is no longer visible in the laryngeal vestibule (between the arytenoids and epiglottic base) 29 …”

“…28 • UESO offset: The time of the first frame in which air or barium contrast is completely cleared from the UES region. 27 • LVC: The time of the first frame in which air space is no longer visible in the laryngeal vestibule (between the arytenoids and epiglottic base). 29 • Laryngeal vestibule reopening (LVO): The time of the first frame of obvious air space reappearance within the laryngeal vestibule.…”