Catherine R. Lintzenich

Aging-Related Geniohyoid Muscle Atrophy Is Related to Aspiration Status in Healthy Older Adults

BACKGROUND Age-related muscle weakness due to atrophy and fatty infiltration in orofacial muscles may be related to swallowing deficits in older adults. An important component of safe swallowing is the geniohyoid (GH) muscle, which helps elevate and stabilize the hyoid bone, thus protecting the airway. This study aimed to explore whether aging and aspiration in older adults were related to GH muscle atrophy and fatty infiltration. METHOD Eighty computed tomography scans of the head and neck from 40 healthy older (average age 78 years) and 40 younger adults (average age 32 years) were analyzed. Twenty aspirators and 20 nonaspirators from the 40 older adults had been identified previously. Two-dimensional views in the sagittal and coronal planes were used to measure the GH cross-sectional area and fatty infiltration. RESULTS GH cross-sectional area was larger in men than in women (p < .05). Decreased cross-sectional area was associated with aging (p < .05), and cross-sectional area was significantly smaller in aspirators compared with nonaspirators, but only among the older men (p < .01). Increasing fatty infiltration was associated with aging in the middle (p < .05) and posterior (p < .01) portions of the GH muscle. There was no significant difference in fatty infiltration of the GH muscle among aspirators and nonaspirators. CONCLUSION GH muscle atrophy was associated with aging and aspiration. Fatty infiltration in the GH muscle was increased with aging but not related to aspiration status. These findings suggest that GH muscle atrophy may be a component of decreased swallowing safety and aspiration in older adults and warrants further investigation.

Isometric and swallowing tongue strength in healthy adults

The tongue contributes to a safe swallow. It facilitates bolus control during mastication, maintains a bolus in the oral cavity to prevent premature entry of the bolus into the hypopharynx, and helps generate pressure in the hypopharynx during swallowing. This study examined isometric tongue strength and tongue pressure measured during swallowing in healthy young and older adults.

Factors Influencing Bolus Dwell Times in Healthy Older Adults Assessed Endoscopically

Scant data exist on normal bolus dwell time assessed during flexible endoscopic evaluation of swallowing (FEES). The purpose of this study was to examine bolus dwell time in healthy older adults. Because it has been previously reported that some healthy older adults aspirate, we also sought to determine if bolus dwell time varied as a function of aspiration status.

Age-related changes of hyoid bone position in healthy older adults with aspiration

Aspiration, the passage of a bolus below the vocal folds, increases morbidity and mortality in the elderly by increasing the risk of aspiration pneumonia and other conditions. We hypothesized that altered position of the hyoid bone associated with aging may negatively affect airway protection during swallowing (i.e., aspiration) in older adults.

The Effects of topical anesthetic on swallowing during nasoendoscopy

To assess the effects of a typical otolaryngologic dose of 1 mL of 4% lidocaine on penetration aspiration scale scores and participant discomfort during flexible endoscopic evaluation of swallowing.

Effects of effortful swallow on esophageal function in healthy adults

Background  Treatment for esophageal dysmotility is currently limited to primarily pharmacologic intervention, which has questionable utility and frequently associated negative side effects. A potential behavioral intervention for esophageal dysmotility is the effortful oropharyngeal swallow. A previous pilot study using water perfusion manometry found an increase in distal esophageal amplitudes during effortful vs non‐effortful swallowing. The current study sought to duplicate the previous study with improvements in methodology.

Simulation model for tracheotomy education for primary health-care providers.

Objectives: We performed this study to evaluate the competency of health-care providers managing patients with tracheotomies, and assess the need for, and efficacy of, a multidisciplinary educational program incorporating patient simulation. Methods: The prospective observational study included 87 subjects who manage patients with tracheotomies within a tertiary-care hospital. The subjects completed self-assessment questionnaires and objective multiple-choice tests before and after attending a comprehensive educational course using patient simulation. The outcome measurements included pre-course and post-course questionnaire and test scores, as well as observational data collected during recorded patient simulation sessions. Results: Before the education and simulation, the subjects reported an average comfort level of 3.3 on a 5-point Likert scale across 10 categories in the questionnaire, which improved to 4.4 after the training (p < 0.0001). The subjects’ mean scores improved from 56% on the pre-course test to 91% on the post-course test (p < 0.0001). The specific deficiencies observed during patient simulation scenarios included unfamiliarity with different tracheotomy tube types, misunderstanding of speaking valve physiology, and delayed recognition and treatment of a plugged or dislodged tracheotomy tube. Conclusions: There is a significant need for improved tracheotomy education among primary health-care providers. Incorporating patient simulation into a comprehensive tracheotomy educational program was effective in improving provider confidence, increasing provider knowledge, and teaching the skills necessary for managing patients with a tracheotomy.

Stability of aspiration status in healthy adults.

Objectives: In multiple separate studies, we consistently found that approximately 30% of asymptomatic healthy older adults silently aspirated liquids during flexible endoscopic evaluation of swallowing (FEES). We subsequently questioned whether aspiration status remained stable in healthy older adults over time. The purpose of this study was to determine the stability of aspiration status in healthy older adults over time. Methods: Eighteen healthy older participants, comprising of 9 aspirators and 9 nonaspirators whose aspiration status was identified in a previous study, underwent a second FEES approximately 6 to 21 months later. The participants contributed 36 swallows, comprising 5-, 10-, 15-, and 20-mL boluses of milk (ie, 1 bolus of each volume of skim, 2%, whole, and soy milk) and water via cup and straw delivery, during the original FEES. An abbreviated protocol was administered for the repeat FEES. The Penetration-Aspiration Scale was used to rate all swallows. Results: A McNemar test demonstrated no change in aspiration status among participants between the initial test and the retest (p > 0.999). Conclusions: In this cohort, the aspiration status was stable over about 12 months. This finding lends credence to the premise that trace aspiration of liquids may be a normal and consistent finding in some healthy older adults.

Computed tomography pulmonary findings in healthy older adult aspirators versus nonaspirators

In previous studies, we consistently found that approximately 30% of asymptomatic healthy older adults silently aspirated liquids during a flexible endoscopic evaluation of swallowing (FEES) and that their aspiration status was stable for the following year. However, no studies have systematically evaluated effects of silent aspiration on lung parenchyma and airways. We used computed tomography (CT) to compare lungs of healthy older adult aspirators versus nonaspirators. We hypothesized that CT images would show pulmonary differences in healthy older adult aspirators versus nonaspirators.

Tongue adiposity and strength in healthy older adults

To identify treatable risk factors for aspiration in older adults, particularly those associated with sarcopenia, we examined tongue composition. We hypothesized that isometric and swallowing posterior tongue strength would positively correlate with posterior tongue adiposity, and healthy older adults who aspirate would have greater tongue adiposity than healthy older adults who did not aspirate.