Displacement of the Hyoid Bone among Normal, Aspirated, and Penetrated Swallows in Post-Stroke Patients with Dysphagia

Hwang, Wooseop; Ha, Seunghee; Hwang, Sujin

ORIGINAL ARTICLE

Commun Sci Disord. 2011;16(3): 372-387.

Wooseop Hwang^` , Seunghee Ha^` , and Sujin Hwang^`

황우섭(Wooseop Hwang)| 하승희(Seunghee Ha)| 황수진(Sujin Hwang)

ABSTRACT

Background & Objectives
Displacement of the hyoid bone is important for predicting aspiration as it influences epiglottic inversion, laryngeal elevation, and cricopharyngeal muscle opening. The purpose of this study was to investigate whether there are differences in the displacement of the hyoid bone among normal, aspirated, and penetrated swallows in post-stroke patients with dysphagia using an objective and quantitative assessment method. Also, the study aimed to explore which quantitative measures best explained the differences among normal, aspirated, and penetrated swallows.
Methods
Thirty post-stroke patients showing dysphagia received videofluoroscopic swallow assessment. Subjects performed two swallows of a 5cc bolus of liquid barium. Subjects who showed aspiration during the first swallow did not proceed to the next swallow for safety reasons. Fifty-eight swallows from 30 patients were divided into 25 normal swallows (non-penetration and aspiration), 15 aspirations, and 18 penetrations. Three measurements reflecting the movement patterns of the hyoid bone, (1) maximum anterior displacement of hyoid bone, (2) maximum superior displacement, and (3) maximum anterior-superior displacement, were obtained.
Results
Maximum anterior displacement and maximum superior displacement of the hyoid bone did not show significant differences among the three types (penetration, aspiration, non-penetration and aspiration). However, maximum anterior-superior displacement in non-penetration and aspiration was significantly larger than that in aspiration. Discussion & Conclusions: The results of this study support the finding that the limited displacement of the hyoid bone increases the risk of aspiration during and after swallows. This study also suggests that maximum anterior-superior displacement, which reflects simultaneous anterior and superior displacement of the hyoid bone, might be a more appropriate predictor of aspiration. In addition, this study suggests that the quantitative measurement of the displacement of hyoid bone can be used to objectively evaluate patients’ swallowing abilities and the effectiveness of treatments.

Keywords: 삼킴장애 | 설골 | 흡인 | 침습 | 뇌졸중 | 비디오투시조영검사 | dysphagia