Clinical and Electromyographic Assessment of Swallowing in Individuals with Functional Dysphonia Associated with Dysphagia Due to Muscle Tension or Atypical Swallowing

Introduction: Over the past few years, attention has been paid to the coexistence of dysphonia with dysphagia, in the context of functional disorders. The aim of this work was to objectify logopaedic examination of dysphonic patients with coexisting swallowing difficulties by surface electromyography. Methods: The material of the work included 58 patients with muscle tension dysphonia (MTD). Each patient underwent otolaryngologic, phoniatric and logopaedic examination. We collected information about medical history and asked patients to fill out Reflux Symptom Index (RSI), Eating Assessment Tool (EAT-10), Dysphagia Handicap Index (DHI) and Swallowing Disorder Scale (SDS). The algorithm of dysphagia diagnostics in our clinic assumes parallel surface electromyography (SEMG) during Functional Endoscopic Evaluation of Swallowing. Results: In comparison to patients suffering from atypical swallowing, patients with muscle tension dysphagia (MTDg) obtained higher values from almost all questionnaires. Logopaedic evaluation revealed abnormalities in the structure and efficiency of the articulatory organs and in the assessment of primary functions. Patients with more abnormalities in logopaedic examination had significantly higher infrahyoid muscle activity during swallowing observed in EMG. Patients with non-normative swallowing pattern had significantly greater asymmetry of the average and maximum amplitude of masseters, as well as submental muscles. Patients with higher percent of muscles asymmetry gained higher scores in questionnaires. Conclusions: Surface electromyography objectifies logopaedic examination of patients with swallowing difficulties. The results of this work showed that, apart from longer swallows, patients with MTDg differ from patients with non-normative swallowing patterns in the muscle activity measured by SEMG, abnormalities in logopaedic evaluation and the severity of complaints reported by patients.

Cytokine and Growth Factor Response in a Rat Model of Radiation Induced Injury to the Submental Muscles

ABSTRACTSubmental muscles (i.e. mylohyoid and geniohyoid) play a vital role during swallowing, protecting the airway from ingested material. To design therapies to reduce the functional deficits associated with radiation treatment relies in part on our understanding of the changes in the cytokine and growth factor response that can impact muscle function. The purpose of this study is to quantify changes in the inflammatory, pro-fibrotic, and pro-angiogenic factors following 48Gy of fractionated radiation to the mylohyoid muscle. We hypothesized that (1) irradiation will provoke increases in TGF-1β and MMP-2 mRNA in the mylohyoid muscle; and (2) muscles surrounding the target location (i.e. geniohyoid and digastric muscles) will exhibit similar alterations in their gene expression profiles. Rats were exposed to 6 fractions of 8Gy using a 6MeV electron beam on a clinical linear accelerator. The highest dose curve was focused at the mylohyoid muscle. After 2-and 4-weeks post-radiation, the mylohyoid, geniohyoid, and digastric muscles were harvested. Expression of TNF-α, IFNγ, IL-1β, IL-6, TGF-1β, VEGF, MMP-2, and MMP-9 mRNA was analyzed via PCR and/or RT-PCR. TGF-1β, MMP-2, and IL-6 expression was upregulated in the irradiated mylohyoid compared to nonirradiated controls. No notable changes in TNF-α, IFNγ, and IL-1β mRNA expression was observed in irradiated muscles. Differing expression profiles were found in the surrounding muscles post-radiation. Results demonstrated that irradiation provokes molecular signals involved in the regulation of the extracellular matrix, which could lead to fibrosis or atrophy in the swallowing muscle after radiation.

Effects of Prophylactic Swallowing Exercises on Dysphagia and Quality of Life in Patients with Head and Neck Cancer Receiving (Chemo) Radiotherapy. The Redyor Study: Protocol for a Randomized Clinical Trial.

Background: Squamous carcinoma of the head and neck (HNC) has a high incidence in our context. Although therapeutic radiotherapy protocols try to preserve swallowing function and essential speech organs, dysphagia is a frequent symptom in the acute and long-term phases, due to the toxic effects of therapies needed to confront the illness. Some studies have shown prophylactic oropharyngeal exercises to be quite useful in improving swallowing function after completion of chemo-radiation therapy (CRT) protocols; others have focused on their use to prevent or minimize post-CRT swallowing dysfunction. Patients’ quality of life deteriorates greatly during CRT, with a peak of maximum intensity during the days immediately after finishing CRT treatment. Afterwards, function gradually improves, although scope or timeframe remains undetermined. Available evidence suggests that exercise therapy prior to oncological treatment could potentially improve deglutition and quality of life; however, a randomized study is needed to confirm this observation. Design/Methods: The Redyor singe-blind randomized clinical trial is designed to compare the effect of prophylactic oropharyngeal exercises on quality of life, dysphagia, and sustainability to the length of rehabilitative treatment. At enrollment, participants will be randomly assigned to one of two treatment groups. Both groups follow the protocol described here, although one group begins the training 2 weeks before initiating CRT and the other group just after finishing the therapy. Both groups will complete standard swallow therapy for training submental muscles involved and 3 sets of 5 inspiratory and expiratory repetitions using the Orygen Dual® valve, with a progressive weekly increase in workload. Discussion: This ongoing clinical trial, registered in 2016, is based on the hypothesis that undergoing a pre-radiotherapy rehabilitation (pre-habilitation) program will have greater benefits (less decrease in quality of life, less delay in swallowing parameters, and less severe dysphagia) compared to post-CRT rehabilitation. The primary objective is to assess dysphagia severity and evaluate quality of life due to swallowing dysfunction in HNC patients. Secondary objectives are to assess the correlation between a clinical variable and instrumental parameters in this period

Effects of Prophylactic Swallowing Exercises on Dysphagia and Quality of Life in Patients with Head and Neck Cancer Receiving (Chemo) Radiotherapy

Background: Squamous carcinoma of the head and neck (HNC) has a high incidence in our context. Although therapeutic radiotherapy protocols try to preserve swallowing function and essential speech organs, dysphagia is a frequent symptom in the acute and long-term phases, due to the toxic effects of therapies needed to confront the illness. Some studies have shown prophylactic oropharyngeal exercises to be quite useful in improving swallowing function after completion of chemo-radiation therapy (CRT) protocols; others have focused on their use to prevent or minimize post-CRT swallowing dysfunction. Patients’ quality of life deteriorates greatly during CRT, with a peak of maximum intensity during the days immediately after finishing CRT treatment. Afterwards, function gradually improves, although scope or timeframe remains undetermined. Available evidence suggests that exercise therapy prior to oncological treatment could potentially improve deglutition and quality of life; however, a randomized study is needed to confirm this observation. Design/Methods: The Redyor singe-blind randomized clinical trial is designed to compare the effect of prophylactic oropharyngeal exercises on quality of life, dysphagia, and sustainability to the length of rehabilitative treatment. At enrollment, participants will be randomly assigned to one of two treatment groups. Both groups follow the protocol described here, although one group begins the training 2 weeks before initiating CRT and the other group just after finishing the therapy. Both groups will complete standard swallow therapy for training submental muscles involved and 3 sets of 5 inspiratory and expiratory repetitions using the Orygen Dual® valve, with a progressive weekly increase in workload. Discussion: This ongoing clinical trial, registered in 2016, is based on the hypothesis that undergoing a pre-radiotherapy rehabilitation (pre-habilitation) program will have greater benefits (less decrease in quality of life, less delay in swallowing parameters, and less severe dysphagia) compared to post-CRT rehabilitation. The primary objective is to assess dysphagia severity and evaluate quality of life due to swallowing dysfunction in HNC patients. Secondary objectives are to assess the correlation between a clinical variable and instrumental parameters in this period

Disorders Involving the Pharynx and Upper Esophagus

A wide variety of disorders can affect the pharynx and upper esophagus, such as inherited or acquired structural abnormalities, malignancies, and inflammation secondary to a number of etiologies including bacterial, yeast and viral infections, irradiation, and gastroesophageal reflux disorder. Laryngoceles and peritonsillar abscess can also lead to pain and dysfunction. However, this review will focus on the main motility disorders that affect the pharynx and upper esophagus, namely oropharyngeal dysphagia, disorders associated with globus pharyngeus, and Zenker’s diverticulum. Figures show the anatomy of the three stages of normal swallow, various findings on functional endoscopic evaluation of swallowing, electromyography of the cricopharyngeal sphincter and submental muscles, and Zenker’s diverticulum. Tables list causes of oropharyngeal dysphagia, neuromuscular control of the pharyngeal phase (with identified cranial and cervical spinal nerve roots), pathophysiology of oropharyngeal dysplasia, diagnostic tests for oropharyngeal dysplasia, behavioral treatments to improve swallow and reduce aspiration, and potential overlapping causes of impaired upper esophageal sphincter relaxation. This review contains 4 highly rendered figures, 6 tables, and 40 references Key words: Oropharyngeal dysphagia; Globus; Upper esophageal sphincter dysfunction; Swallowing disorder; Dysphagia; Zenker’s diverticulum; Swallow assessment; Globus pharyngeus