Catriona Margaret Steele

Purpose: This study aimed to assess the impact of open partial horizontal laryngectomy Type IIa (OPHL-IIa) surgery on swallowing dynamics. OPHL-IIa surgery for laryngeal cancer Stages T1b–T4a offers a promising approach for tumor management, enabling continued oral intake without necessitating tracheostomy, even in the presence of altered pharyngeal and laryngeal anatomy. However, the effects of the surgery on swallowing function and physiology have not been described. Method: The ASPEKT(Analysis of Swallowing Physiology: Events, Kinematics, and Timing) Method was used to analyze pre- and postsurgery videofluoroscopic swallowing study recordings from five participants (four men, one woman; M _age = 61 years; mean postsurgery evaluation at 71 days). The study focused on swallowing dynamics across thin, mildly thick, and extremely thick liquids, as defined by the International Dysphagia Diet Standardisation Initiative. Parameters of interest included Penetration–Aspiration Scale (PAS) scores, timing measures, and pixel-based measures of upper esophageal sphincter opening, pharyngeal area at rest (PhAR), pharyngeal area at maximum constriction, residue, and hypopharyngeal area below the laryngeal aditus. Results: Initial observations highlighted poor pharyngeal constriction presurgery. Postoperatively, there was a notable deterioration in PAS scores, degree of laryngeal vestibule closure, and pharyngeal constriction. Variable changes in PhAR were also noted, potentially reflecting the impact of surgical technique and postsurgical edema. All participants exhibited postsurgical enlargement of the hypopharynx. Conclusion: This study reveals significant changes in swallowing anatomy, function, and physiology following OPHL-IIa surgery, marked by compromised laryngeal vestibule closure, pharyngeal structural changes, and diminished pharyngeal constriction.

In 2015, the International Dysphagia Diet Standardisation Initiative (IDDSI) published a systematic review of evidence describing the impact of liquid consistency and food texture on swallowing [1, 2]. A recent update synthesized new evidence published since 2012 [3]. As part of full-text review, bibliometric and thematic analysis was completed for 465 articles, which met inclusion criteria of reporting quantitative measures of swallowing in humans across at least two consistencies, with a sample size ≥ 10 participants. Study characteristics were extracted using the universal applicable questions domain of the Framework for RigOr aNd Transparency In REseaRch on Swallowing (FRONTIERS; https://www.frontiersframework.com), a critical appraisal tool for evaluating study quality and reporting in dysphagia research. Appraisals were performed independently by two reviewers. Data cleaning and discrepancy resolution were performed by the two lead authors. Thematic analysis identified patterns related to study characteristics, scientific rigor and reporting transparency. Parameters were considered well-reported if present in ≥ 60% of the articles, and poorly-reported when present in ≤ 25%. The included articles originated in 32 different countries around the world: 27% coming from Canada/USA, 23% from Europe, 27% from Asia, and 22% from Latin America, Oceania, and Africa/Middle East. With respect to study populations, 425 (91%) reported data for adult participants and 53 (11%) for pediatric participants, with 137 studies (29%) focusing on healthy swallowing. Critical appraisal highlighted gaps with respect to representation of diverse racial and ethnic groups, and a need for greater clarity in reporting the criteria used to define and measure dysphagia severity in future studies.

Diet texture modification is a common intervention for oropharyngeal dysphagia. In 2015, the International Dysphagia Diet Standardisation Initiative (IDDSI) published a systematic review summarizing evidence on how liquid consistency and food texture influence swallowing behavior. This updated review synthesizes new evidence published between 2012 and 2024 addressing how differences in liquid consistency or food texture affect swallowing in humans. A PROSPERO‑registered, PRISMA‑guided review was conducted using the Covidence platform. A multi‑engine search identified English, peer‑reviewed studies reporting comparable quantitative measures across two or more consistencies defined using IDDSI terminology. Screening and full‑text review were performed in duplicate. Articles were appraised using the FRONTIERS framework, and data synthesis focused on swallowing safety, efficiency, and other physiologic metrics. From 63,247 initial records, 24,196 abstracts were screened and 2,310 full texts reviewed, yielding 465 eligible studies. Of these, 70 studies (from 2017 onward) provided non‑overlapping data mapped to the IDDSI Framework. Sixty‑eight articles reported findings for drink levels 0–4 and 25 for food levels 5–7. Videofluoroscopy was the most common instrumental method used, followed by endoscopy and high‑resolution manometry; other physiologic measures were used less frequently. Across all 25 studies reporting safety outcomes, thicker liquids improved swallowing safety compared with thinner liquids. Among studies reporting efficiency, smaller bolus volumes helped limit residue with thickened liquids. Food textures seldom elicited penetration-aspiration but were associated with increased residue in patient populations. Overall, findings reinforce the need for individualized clinical decision‑making regarding texture modification, informed by careful assessment.

Purpose: The purpose of this study was to characterize swallowing physiology on sips of thin liquid in patients following open partial horizontal laryngectomy Type IIa (OPHLIIa) using videofluoroscopic swallow study (VFSS) data, rated using the Analysis of Swallowing Physiology: Events, Kinematics, and Timing (ASPEKT) method. Method: This retrospective study involved secondary analysis of archived data for a cross-sectional sample of 100 patients (94 men, six women; M _age = 67 years) who underwent VFSS after OPHLIIa surgery at the Brazilian National Cancer Institute (mean time postsurgery = 44 months). For each patient, the first available comfortable sip of thin liquid barium was rated using ASPEKT parameters and additional hypopharyngeal area and cricopharyngeal tissue redundancy measures. Ratings were performed by trained speech-language pathologists using ImageJ software. Values were compared to reference data for adults without dysphagia using t tests and odds ratio analysis. Results: After OPHLIIa surgery, patients in this sample exhibited elevated frequencies and significantly increased odds of atypical findings across multiple swallowing parameters. With respect to impaired swallowing safety and efficiency, these included clinically significant Penetration–Aspiration Scale scores (22%), partial/incomplete laryngeal vestibule closure (LVC; 34%), and increased pharyngeal residue, both overall (76%) and by subspace: valleculae (49%), pyriform sinuses (63%), and elsewhere in the pharynx (57%). Other parameters showing significantly increased odds of atypical findings included reduced pharyngeal constriction (98%), reduced hyoid peak position (83%) and speed (59%), a prolonged hyoid-burst-to-upper-esophageal-sphincter-opening interval (45%), and the presence of redundant cricopharyngeal muscle tissue (39%). The analyses highlighted poor hypopharyngeal constriction as a feature of swallowing post-OPHLIIa and revealed apparent compensations in the form of significantly shorter time-to-LVC and prolonged LVC and upper esophageal sphincter opening durations. Conclusions: Swallowing dysfunction following OPHLIIa is marked by structural and physiological changes that impair both swallowing safety and efficiency. These findings highlight critical physiological impairments, particularly reduced pharyngeal constriction and compromised airway protection, which should be considered during clinical evaluation and decision making.

Background: Pharyngeal shortening is thought to facilitate bolus clearance through the pharynx and upper oesophageal sphincter (UES) in swallowing. However, little information is available regarding pharyngeal shortening in healthy swallowing. Objective(s): We characterised the timing and extent of pharyngeal shortening by tracking the height of the UES across key time points in healthy swallowing. Additionally, we identified variations in pharyngeal shortening attributable to participant (sex, age) and bolus factors (consistency, volume). Methods: Videofluoroscopy data for (1) sips of thin liquid and (2) teaspoons of mildly thick liquid were analysed from 80 healthy adults (40 males, 40 females), distributed across four age groups: 18–35, 36–53, 54–72, 73–90 years. UES height was tracked relative to the cervical spine on the frames of UES opening (UESO), maximum UES height (UESMaxHeight) and swallow rest (SR) using a 20‐point ordinal scale. Statistical analyses explored effects of sex, age‐group, and task on: (1) latency‐to‐UESMaxHeight, (2) UES height at UESO and SR, and (3) the degree of pharyngeal shortening at UESMaxHeight relative to UESO and SR. Results: Maximum UES height occurred between the events of UES opening and closure, in close proximity to other biomechanically linked events. UES height was lower in males. Greater pharyngeal shortening was seen in males and on thin liquid tasks. Conclusion: These findings refine our understanding of healthy swallowing dynamics and highlight the influence of sex‐linked differences in height on UES position relative to the cervical spine. Trial Registration: ClinicalTrials.gov : NCT05497219

Neurological disorders, such as Parkinson's disease and stroke, often lead to neurogenic dysphagia, a swallowing disorder that compromises nutrition and increases the risk of malnutrition, aspiration of food, and even death. Although instrumental assessments remain the gold standard for evaluating swallowing function, their invasiveness, costs, and reliance on specialized clinical facilities limit their routine use. In this scoping review, we provide an overview of emerging noninvasive wearable devices for assessing and monitoring dysphagia in neurological disorders. We highlight the most widely used sensing technologies, such as accelerometers, microphones, and surface electromyography, alone and in multimodal configurations, discuss their respective strengths and limitations, and outline the main challenges and opportunities for advancing this field. Particular attention is given to the need for standardized protocols, robust clinical validation, and the integration of artificial intelligence to enable scalable and precise assessment. We conclude by discussing how these technologies can be applied in clinical practice to support earlier diagnosis, continuous monitoring, and improved management of swallowing function in individuals with neurological disorders.

Purpose: Solid food stimuli (e.g., crackers) are commonly used in videofluoroscopic swallowing studies (VFSS). A variety of additional food textures may be included when exploring the benefit of compensatory strategies. However, interpretation regarding these textures is hindered by a lack of data outlining expected values for measures of swallowing safety, kinematics, timing, and efficiency. We report preliminary data for quantitative VFSS measures with International Dysphagia Diet Standardisation Initiative (IDDSI) food levels MM5 (minced and moist), SB6 (soft-and-bite-sized), and RG7 (regular) in healthy young adults. Method: VFSS were performed at 30 frames per second in 20 participants (10 men, 10 women; M _age = 28 years, range: 23–55) who swallowed two boluses each of MM5 (teaspoon), SB6 (cube 1.5 cm ³ ), and RG7 (bite) barium stimuli. Blinded duplicate rating identified key frames on the initial swallow of each bolus, from which timing measures were derived relative to hyoid burst (HYB) and end of aggregation (EOA). Safety was scored using the 8-point Penetration–Aspiration Scale. Anatomically normalized pixel-based measures of pharyngeal area at maximum pharyngeal constriction (PhAMPC), upper esophageal sphincter maximum distention (UESMAX), and residue were obtained. Intraclass correlations were calculated for reliability; discrepancies were resolved by consensus. Friedman's tests explored differences by texture. The results were compared to previously reported reference data for teaspoons of EX4/PU4 using one-sample t tests. Results: Timing measures relative to HYB increased across textures: MM5 < SB6 < RG7 and were significantly longer than reported values for EX4/PU4. Timing measures calculated relative to EOA did not differ by texture. UES opening duration was significantly longer for MM5 than SB6, RG7, and EX4/PU4. UESMAX distention was significantly smaller for RG7 and EX4/PU4 than MM5 and SB6. PhAMPC was larger for MM5, SB6, and RG7 than EX4/PU4. Total pharyngeal residue was significantly greater for MM5 and RG7 than for SB6 and EX4/PU4. Conclusions: These data suggest that variations in some pharyngeal phase parameters should be expected across IDDSI levels EX4/PU4, MM5, SB6, and RG7. Additional research is needed to elucidate interactions of bolus size and cohesiveness with these texture-related differences. Teaspoons of EX4/PU4 stimuli are insufficient to predict swallowing physiology with higher food texture levels. RG7 stimuli are recommended to test pharyngeal constriction and swallowing efficiency. SB6 stimuli can provide additional insights regarding the benefits of altering bolus properties in terms of swallowing efficiency. Supplemental Material: https://doi.org/10.23641/asha.31592143 .

Objective(s): Serial pharyngeal constrictor muscle contraction during swallowing can be seen fluoroscopically as a wave of posterior pharyngeal wall (PPW) movement. We characterized PPW thickness at rest and during swallowing at three anatomical levels (C2, C3, C4), accounting for effects of sex, age, and task. Methods: Videofluoroscopies were performed in 80 healthy adults (40 males, 40 females), aged 18–90 years. PPW thickness was measured frame‐by‐frame at the inferior borders of C2, C3, and C4 from bolus‐passing mandible to swallow rest on sips of thin liquid and teaspoons of mildly thick liquid. Analyses of variance were used to identify sex, age, and task effects. Results: At rest, PPW thickness increased from C2 and C3 to C4. Older participants had reduced C2 PPW thickness at rest and during swallowing. Females had greater PPW thickness than males across all levels at rest and at C3 during swallowing. Maximum PPW excursion events at C2 and C3 coincided with maximum pharyngeal constriction and UES closure, respectively. Young males showed longer latencies to C2max than young females, while females of all ages showed longer latencies to C3max and C4max. Alterations of the typical C2max < C3max < C4max sequence of PPW excursion were more common in older participants. There were no task differences for any measures of PPW thickness or excursion. Conclusion: This exploratory study suggests that measures of PPW thickness can reveal age‐ and sex‐related differences in pharyngeal muscle bulk and contraction. Future studies are needed to confirm sensitivity to changes related to medical conditions or after dysphagia intervention. Level of Evidence: 4.

Background: Post stroke dysphagia is common and has negative consequences on health and wellbeing. Collectively, behavioural interventions including swallow strength and skill training with biofeedback improve dysphagia, but little is known about which interventions are most effective and at what dose. Early intensive intervention may be most beneficial for motor recovery, but it is unclear whether dysphagia therapy such as this is feasible to deliver in the inpatient acute stage. Aim: To understand the feasibility of clinical teams delivering swallow strength and skill training with biofeedback in acute inpatient stroke and explore which dose may result in better outcomes. Methods: One hundred twenty participants from inpatient stroke units 1–8 weeks post stroke in the UK will be recruited in this multi-centre prospective randomised controlled feasibility trial. If eligible, they will be randomised 1:1:1 to either usual care, low-intensity therapy (once daily) or high-intensity therapy (twice daily) groups. In addition to usual care, treatment groups will receive 1 or 2 × 35-min daily sessions of swallow strength and skill training with surface electromyographic biofeedback over 2 weeks. The primary outcome is feasibility measured by recruitment and treatment fidelity. Secondary outcomes will explore treatment effects and dose of the intervention on swallowing, clinical, quality of life and health economic outcomes. Embedded qualitative process evaluation of intervention delivery (fidelity, barriers and enablers), clinical staff training and trial procedures informed by the Conceptual Framework for Intervention Fidelity (CFIF) and Conceptual Framework for Implementation Research (CFIR). Criteria have been outlined for progression to a definitive study. Discussion: This trial will inform the feasibility of a definitive study to determine the effectiveness of optimal dose swallow strength and skill training with surface electromyographic biofeedback on the severity of dysphagia 3 months post stroke. The process evaluation will inform refinements to the intervention, training and trial procedures to ensure effective delivery. Trial registration: Registration Clinical Trials.gov NCT05744245, date of release 20/12/2022.