Susan G. Butler

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.

Penetration and Aspiration in Healthy Older Adults as Assessed during Endoscopic Evaluation of Swallowing

Objectives: A previous article from our group presented data on normal swallowing as assessed during simultaneous manometry and flexible endoscopic evaluation of swallowing (FEES). Because penetration and aspiration events were identified in healthy adults, the question arose, could the presence of the manometric catheter confound normal FEES findings? Thus, a follow-up study was designed to address the effects of catheter condition on healthy older adults as assessed during FEES. Methods: Twenty older adults (mean, 78.9 years of age) participated. The participants each contributed 28 swallows, affording a study total of 560 swallows for analyses. Results: The older adults demonstrated penetration on 82 (15%) and aspiration on 18 (3%) of 545 swallows. The numbers of participants who had penetration and aspiration during the study protocol were 75% and 30%, respectively. The older adults demonstrated both penetration and aspiration events irrespective of the presence of a catheter; whether they were drinking milk, water, or barium; whether the bolus was 5 or 10 mL; and whether they took the bolus via syringe or self-administered the bolus with a cup. However, significantly more aspiration was found on thin liquids than on puree or solids. Conclusions: Endoscopic data on normal swallowing physiology were generated. These may serve as an accurate benchmark for clinicians and researchers in the interpretation of dysphagia.

Maximum Phonation Time in Healthy Older Adults

OBJECTIVES/HYPOTHESIS Maximum phonation time (MPT), a clinical measurement of the longest time one can phonate a vowel, typically /a/, is a frequently used measure of vocal function, but normative data are lacking for MPT in healthy older adults. The aim of this study was to provide data on MPT in healthy older adults and to determine the effect of advanced age, gender, and repeated measures on MPT. STUDY DESIGN Prospective. METHODS Sixty-nine healthy older adult volunteers participated (ie, 15, 26, and 28 in the seventh, eighth, and ninth decades of life, respectively). The effects of age, gender, and repeated measures (three trials in a single session) on MPT were assessed. Mean, standard deviation, compound symmetry covariance, analysis of variance, and analysis of covariance were used for statistical analysis. RESULTS Neither age group, gender, trial, nor their interactions was statistically significant (P>0.05). Adults in the seventh, eighth, and ninth decades of life had mean MPTs of 22.27 (standard error [SE]=1.56), 22.97 (SE=1.11), and 21.14 (SE=0.97) seconds, respectively. Females and males had mean MPTs of 20.96 (SE=0.92) and 23.23 (SE=0.96) seconds, respectively. Finally, MPTs for trials 1, 2, and 3 were 21.77 (SE=1.09), 21.67 (SE=1.12), and 22.80 (SE=1.27), respectively. CONCLUSIONS MPTs were longer in this group of older adults than previously reported and did not vary significantly with age or gender. Additionally, across a single short sampling session, measurements were relatively stable across three trials of MPTs.

Effects of Viscosity, Taste, and Bolus Volume on Swallowing Apnea Duration of Normal Adults

OBJECTIVE: The effects of viscosity, taste, and nectar-thick liquid bolus volume on swallowing apnea duration (SAD) were examined. STUDY DESIGN AND SETTING: Twenty-two adults, comprised of 10 males and 12 females, participated. SAD was assessed via nasal airflow during swallow conditions of viscosity (thin liquid, thick liquid, and puree), taste (water, apple juice, lemon concentrate), and nectar-thick liquid bolus volumes (5, 10, 15, and 20 mL) across three trials. RESULTS: A significant main effect of nectar-thick liquid bolus volume was found (P < 0.05). Viscosity and taste were not significant. CONCLUSIONS: SAD increased with increases in bolus volume; however, neither changes in bolus viscosity nor changes in taste affected SAD. SIGNIFICANCE: These findings indicate that since viscosity was not significant, the normative data previously published (by this PI) with 60 healthy adults stratified by age and gender can be utilized for comparison to disordered swallowing without regard to the bolus viscosity being used. EBM rating: D. (Otolaryngol Head Neck Surg 2004;131:860–3.)

Factors Influencing Aspiration During Swallowing in Healthy Older Adults

Although flexible endoscopic evaluation of swallowing (FEES) is an established diagnostic tool, little data exist on the effects of varying liquid types on the swallowing outcomes in healthy older adults.

Dural arteriovenous fistula: diagnosis, treatment, and outcomes.

The objective of this study is to determine the sensitivity of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) compared to the gold standard, conventional carotid angiography, in the diagnosis of a dural arteriovenous fistula (DAVF). Further objectives include identifying outcomes of treatment and complications as a function of pretreatment radiologic classification.

Effects of Liquid Type, Delivery Method, and Bolus Volume on Penetration-Aspiration Scores in Healthy Older Adults During Flexible Endoscopic Evaluation of Swallowing

Objectives: The type of liquid (eg, water or milk) that should be used during flexible endoscopic evaluation of swallowing (FEES) has received little investigation. Aspiration may vary as a function of the thin liquid type used during FEES. Methods: We measured the effects of liquid type (water, skim milk, 2% milk, and whole milk; all dyed with green food coloring), delivery method (cup and straw), and bolus volume (5, 10, 15, and 20 mL) on Penetration-Aspiration Scale (PAS) scores in 14 healthy older adults (mean, 75 years; range, 69 to 85 years). Each participant generated 32 swallows. Results: The PAS scores differed significantly by liquid type (p = 0.003) and by bolus volume (p = 0.017), but not by delivery method (p = 0.442). The PAS scores were significantly greater for 2% milk and whole milk than for skim milk and water (p < 0.05), and for 20 mL versus smaller volumes. Penetration and aspiration were observed on 113 (25%) and 15 (3%) of 448 swallows, respectively. Conclusions: These findings suggest that both milk and water should be used during FEES for an accurate assessment of aspiration status.

Laryngopharyngeal abnormalities in hospitalized patients with dysphagia.

Objectives: To determine the prevalence of laryngopharyngeal (LP) abnormalities in hospitalized patients with dysphagia referred for flexible endoscopic evaluation of swallowing (FEES).

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.