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  • Review Article
  • Published:

Oropharyngeal dysphagia: manifestations and diagnosis

Nature Reviews Gastroenterology & Hepatology volume 13, pages 49–59 (2016)Cite this article

Subjects

Key Points

  • Oropharyngeal dysphagia is a common disability that can manifest in a variety of ways

  • Respiratory complications and psychosocial issues are often unrecognized in patients with oropharyngeal dysphagia

  • Videofluoroscopy and fibreoptic endoscopic evaluation of swallowing are the current gold-standard investigations for oropharyngeal dysphagia

  • Despite considerable effort, these conventional diagnostic methods have limited proven accuracy in predicting aspiration and respiratory disease

  • Emerging evidence shows that novel techniques such as high-resolution manometry with impedance, functional lumen imaging probe and accelerometry could have a role in the diagnosis of oropharyngeal dysphagia

  • Incorporation of measurable objective assessments into clinical diagnosis is needed and could reveal subtle abnormalities that are key to distinguish pathology of oropharyngeal dysphagia and develop new therapeutic strategies

Abstract

Swallowing disorders (dysphagia) have been recognized by the WHO as a medical disability associated with increased morbidity, mortality and costs of care. With increasing survival rates and ageing of the population, swallowing disorders and their role in causing pulmonary and nutritional pathologies are becoming exceedingly important. Over the past two decades, the study of oropharyngeal dysphagia has been approached from various disciplines with considerable progress in understanding its pathophysiology. This Review describes the most frequent manifestations of oropharyngeal dysphagia and the clinical as well as instrumental techniques that are available to diagnose patients with dysphagia. However, the clinical value of these diagnostic tests and their sensitivity to predict outcomes is limited. Despite considerable clinical research efforts, conventional diagnostic methods for oropharyngeal dysphagia have limited proven accuracy in predicting aspiration and respiratory disease. We contend that incorporation of measurable objective assessments into clinical diagnosis is needed and might be key in developing novel therapeutic strategies.

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Figure 1: Diagnostic options for oropharyngeal dysphagia.
Figure 2: Lateral videofluoroscopic view and high-resolution manometry colour plot of a liquid (10 ml water) swallow.
Figure 3: Geometric profile of the UES.

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References

  1. World Health Organization. International classification of functioning, disability and health (ICF) (WHO, 2001).

  2. Martino, R., Beaton, D. & Diamant, N. E. Perceptions of psychological issues related to dysphagia differ in acute and chronic patients. Dysphagia 25, 26–34 (2010).

    Article  PubMed  Google Scholar 

  3. McHorney, C. A. et al. The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia 17, 97–114 (2002).

    Article  PubMed  Google Scholar 

  4. Gustafsson, B. & Tibbling, L. Dysphagia, an unrecognized handicap. Dysphagia 6, 193–199 (1991).

    Article  CAS  PubMed  Google Scholar 

  5. Stuchell, R. N. & Mandel, I. D. Salivary gland dysfunction and swallowing disorders. Otolaryngol. Clin. North Am. 21, 649–661 (1988).

    CAS  PubMed  Google Scholar 

  6. Altman, K. W., Yu, G.-P. & Schaefer, S. D. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch. Otolaryngol. Head Neck Surg. 136, 784–789 (2010).

    Article  PubMed  Google Scholar 

  7. Roden, D. F. & Altman, K. W. Causes of dysphagia among different age groups: a systematic review of the literature. Otolaryngol. Clin. North Am. 46, 965–987 (2013).

    Article  PubMed  Google Scholar 

  8. Doty, R. W. & Bosma, J. F. An electromyographic analysis of reflex deglutition. J. Neurophysiol. 19, 44–60 (1956).

    Article  CAS  PubMed  Google Scholar 

  9. Prosiegel, M. Dysphagia: Diagnosis and Treatment (2012).

    Google Scholar 

  10. Clavé, P., Terré, R., de Kraa, M. & Serra, M. Approaching oropharyngeal dysphagia. Rev. Esp. Enferm. Dig. 96, 119–131 (2004).

    Article  PubMed  Google Scholar 

  11. Wallace, K. L., Middleton, S. & Cook, I. J. Development and validation of a self-report symptom inventory to assess the severity of oral-pharyngeal dysphagia. Gastroenterology 118, 678–687 (2000).

    Article  CAS  PubMed  Google Scholar 

  12. Roy, N., Stemple, J., Merrill, R. M. & Thomas, L. Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann. Otol. Rhinol. Laryngol. 116, 858–865 (2007).

    Article  PubMed  Google Scholar 

  13. Go, A. S. et al. Heart disease and stroke statistics —2014 update: a report from the American Heart Association. Circulation 129, e28–e292 (2014).

    Article  PubMed  CAS  Google Scholar 

  14. Heuschmann, P. U. et al. Predictors of in-hospital mortality and attributable risks of death after ischemic stroke: the German Stroke Registers Study Group. Arch. Intern. Med. 164, 1761–1768 (2004).

    Article  PubMed  Google Scholar 

  15. Martino, R. et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 36, 2756–2763 (2005).

    Article  PubMed  Google Scholar 

  16. Mann, G., Hankey, G. J. & Cameron, D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke 30, 744–748 (1999).

    Article  CAS  PubMed  Google Scholar 

  17. Meng, N. H., Wang, T. G. & Lien, I. N. Dysphagia in patients with brainstem stroke: incidence and outcome. Am. J. Phys. Med. Rehabil. 79, 170–175 (2000).

    Article  CAS  PubMed  Google Scholar 

  18. Teasell, R., Foley, N., Fisher, J. & Finestone, H. The incidence, management, and complications of dysphagia in patients with medullary strokes admitted to a rehabilitation unit. Dysphagia 17, 115–120 (2002).

    Article  PubMed  Google Scholar 

  19. Calis, E. A. et al. Dysphagia in children with severe generalized cerebral palsy and intellectual disability. Dev. Med. Child Neurol. 50, 625–630 (2008).

    Article  PubMed  Google Scholar 

  20. Ward, E. C., Uriarte, M. & Conroy, A.-L. Duration of dysphagic symptoms and swallowing outcomes after thermal burn injury. J. Burn Care Rehabil. 22, 441–453 (2001).

    Article  CAS  PubMed  Google Scholar 

  21. Ward, E. C., Green, K. & Morton, A. L. Patterns and predictors of swallowing resolution following adult traumatic brain injury. J. Head Trauma Rehabil. 22, 184–191 (2007).

    Article  PubMed  Google Scholar 

  22. Hutcheson, K. A. & Lewin, J. S. Functional outcomes after chemoradiotherapy of laryngeal and pharyngeal cancers. Curr. Oncol. Rep. 14, 158–165 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Frempong-Boadu, A. et al. Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment. J. Spinal Disord. Tech. 15, 362–368 (2002).

    Article  PubMed  Google Scholar 

  24. Sura, L., Madhavan, A., Carnaby, G. & Crary, M. A. Dysphagia in the elderly: management and nutritional considerations. Clin. Interv. Aging 7, 287–298 (2012).

    PubMed  PubMed Central  Google Scholar 

  25. Cabre, M. et al. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing 39, 39–45 (2010).

    Article  PubMed  Google Scholar 

  26. Oh, T. H. et al. Dysphagia in inflammatory myopathy: clinical characteristics, treatment strategies, and outcome in 62 patients. Mayo Clin. Proc. 82, 441–447 (2007).

    Article  PubMed  Google Scholar 

  27. Ko, E. H. & Rubin, A. D. Dysphagia due to inclusion body myositis: case presentation and review of the literature. Ann. Otol. Rhinol. Laryngol. 123, 605–608 (2014).

    Article  PubMed  Google Scholar 

  28. Alagiakrishnan, K., Bhanji, R. A. & Kurian, M. Evaluation and management of oropharyngeal dysphagia in different types of dementia: a systematic review. Arch. Gerontol. Geriatr. 56, 1–9 (2013).

    Article  PubMed  Google Scholar 

  29. Mills, R., Bahroo, L. & Pagan, F. An update on the use of botulinum toxin therapy in Parkinson's disease. Curr. Neurol. Neurosci. Rep. 15, 511 (2015).

    Article  PubMed  CAS  Google Scholar 

  30. Logemann, J. A. Effects of aging on the swallowing mechanism. Otolaryngol. Clin. North Am. 23, 1045–1056 (1990).

    CAS  PubMed  Google Scholar 

  31. Feinberg, M. J., Ekberg, O., Segall, L. & Tully, J. Deglutition in elderly patients with dementia: findings of videofluorographic evaluation and impact on staging and management. Radiology 183, 811–814 (1992).

    Article  CAS  PubMed  Google Scholar 

  32. Kalf, J. G., de Swart, B. J., Bloem, B. R. & Munneke, M. Prevalence of oropharyngeal dysphagia in Parkinson's disease: a meta-analysis. Parkinsonism Relat. Disord. 18, 311–315 (2012).

    Article  CAS  PubMed  Google Scholar 

  33. Palmer, J. B., Drennan, J. C. & Baba, M. Evaluation and treatment of swallowing impairments. Am. Fam. Physician 61, 2453–2462 (2000).

    CAS  PubMed  Google Scholar 

  34. Bartlett, J. G. Aspiration pneumonia in adults. UpToDate [online], (2010).

    Google Scholar 

  35. Baine, W. B., Yu, W. & Summe, J. P. Epidemiologic trends in the hospitalization of elderly Medicare patients for pneumonia, 1991–1998. Am. J. Publ. Health 91, 1121–1123 (2001).

    Article  CAS  Google Scholar 

  36. Connolly, M. J. Of proverbs and prevention: aspiration and its consequences in older patients. Age Ageing 39, 2–4 (2010).

    Article  PubMed  Google Scholar 

  37. Marik, P. E. & Kaplan, D. Aspiration pneumonia and dysphagia in the elderly. Chest 124, 328–336 (2003).

    Article  PubMed  Google Scholar 

  38. Tablan, O. C., Anderson, L. J., Besser, R., Bridges, C. & Hajjeh, R. Guidelines for preventing health-care-associated pneumonia: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm. Rep. 53, 1–36 (2004).

    PubMed  Google Scholar 

  39. Leibovitz, A. et al. Dehydration among long-term care elderly patients with oropharyngeal dysphagia. Gerontology 53, 179–183 (2007).

    Article  CAS  PubMed  Google Scholar 

  40. Palmer, L. B. Oral clearance and pathogenic oropharyngeal colonization in the elderly. Am. J. Respir. Crit. Care Med. 164, 464–468 (2001).

    Article  CAS  PubMed  Google Scholar 

  41. Suominen, M. et al. Malnutrition and associated factors among aged residents in all nursing homes in Helsinki. Eur. J. Clin. Nutr. 59, 578–583 (2005).

    Article  CAS  PubMed  Google Scholar 

  42. Serra-Prat, M. et al. Oropharyngeal dysphagia as a risk factor for malnutrition and lower respiratory tract infection in independently living older persons: a population-based prospective study. Age Ageing 41, 376–381 (2012).

    Article  PubMed  Google Scholar 

  43. Finestone, H. M., Foley, N. C., Woodbury, M. G. & Greene-Finestone, L. Quantifying fluid intake in dysphagic stroke patients: a preliminary comparison of oral and nonoral strategies. Arch. Phys. Med. Rehabil. 82, 1744–1746 (2001).

    Article  CAS  PubMed  Google Scholar 

  44. Foley, N. C., Martin, R. E., Salter, K. L. & Teasell, R. W. A review of the relationship between dysphagia and malnutrition following stroke. J. Rehabil. Med. 41, 707–713 (2009).

    Article  PubMed  Google Scholar 

  45. Sellars, C. et al. Risk factors for chest infection in acute stroke: a prospective cohort study. Stroke 38, 2284–2291 (2007).

    Article  PubMed  Google Scholar 

  46. Furman, E. F. Undernutrition in older adults across the continuum of care: nutritional assessment, barriers, and interventions. J. Gerontol. Nurs. 32, 22–27 (2006).

    Article  PubMed  Google Scholar 

  47. Eslick, G. D. & Talley, N. J. Dysphagia: epidemiology, risk factors and impact on quality of life—a population-based study. Aliment. Pharmacol. Ther. 27, 971–979 (2008).

    Article  CAS  PubMed  Google Scholar 

  48. Brunnström, H. R. & Englund, E. M. Cause of death in patients with dementia disorders. Eur. J. Neurol. 16, 488–492 (2009).

    Article  PubMed  Google Scholar 

  49. Zuliani, G. et al. Discharge diagnosis and comorbidity profile in hospitalized older patients with dementia. Int. J. Geriatr. Psychiatry 27, 313–320 (2012).

    Article  PubMed  Google Scholar 

  50. Dusick, A. Investigation and management of dysphagia. Semin. Pediatr. Neurol. 10, 255–264 (2003).

    Article  PubMed  Google Scholar 

  51. Prasse, J. E. & Kikano, G. E. An overview of pediatric dysphagia. Clin. Pediatr. (Phila.) 48, 247–251 (2009).

    Article  Google Scholar 

  52. Abadie, V. & Couly, G. Congenital feeding and swallowing disorders. Handb. Clin. Neurol. 113, 1539–1549 (2013).

    Article  PubMed  Google Scholar 

  53. Arvedson, J. C. Management of pediatric dysphagia. Otolaryngol. Clin. North Am. 31, 453–476 (1998).

    Article  CAS  PubMed  Google Scholar 

  54. Ekberg, O., Hamdy, S., Woisard, V., Wuttge-Hannig, A. & Ortega, P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia 17, 139–146 (2002).

    Article  PubMed  Google Scholar 

  55. Shaker, R. et al. Manual of Diagnostic and Therapeutic Techniques for Disorders of Deglutition (Springer, 2013).

    Book  Google Scholar 

  56. Leonard, R. & Kendall, K. Dysphagia Assessment and Treatment Planning (Plural Publishing Inc., 2013).

    Google Scholar 

  57. McCullough, G. H. & Martino, R. in Manual of Diagnostic and Therapeutic Techniques for Disorders of Deglutition (eds Shaker, R. et al.) 11–30 (Springer, 2013).

    Book  Google Scholar 

  58. Hinchy, J. A. et al. Formal dysphagia screening protocols prevent pneumonia. Stroke 36, 1972–1976 (2005).

    Article  Google Scholar 

  59. Kertscher, B., Speyer, R., Palmieri, M. & Plant, C. Bedside screening to detect oropharyngeal dysphagia in patients with neurological disorders: an updated systematic review. Dysphagia 29, 204–212 (2014).

    Article  PubMed  Google Scholar 

  60. Park, Y. H., Bang, H. L., Han, H. R. & Chang, H. K. Dysphagia screening measures for use in nursing homes: a systematic review. J. Kor. Acad. Nurs. 45, 1–13 (2015).

    Article  Google Scholar 

  61. Martino, R. et al. The Toronto Bedside Swallowing Screening Test (TOR-BSST): development and validation of a dysphagia screening tool for patients with stroke. Stroke 40, 555–561 (2009).

    Article  PubMed  Google Scholar 

  62. Clavé, P. et al. Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin. Nutr. 27, 806–815 (2008).

    Article  PubMed  Google Scholar 

  63. Perry, L. Screening swallowing function of patients with acute stroke. Part one: identification, implementation and initial evaluation of a screening tool for use by nurses. J. Clin. Nurs. 10, 463–473 (2001).

    Article  CAS  PubMed  Google Scholar 

  64. Perry, L. Screening swallowing function of patients with acute stroke. Part two: detailed evaluation of the tool used by nurses. J. Clin. Nurs. 10, 474–481 (2001).

    Article  CAS  PubMed  Google Scholar 

  65. Trapl, M. et al. Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen. Stroke 38, 2948–2952 (2007).

    Article  PubMed  Google Scholar 

  66. Logemann, J. Evaluation and Treatment of Swallowing Disorders (Pro-Ed, 1997).

    Google Scholar 

  67. Belafsky, P. C. et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann. Otol. Rhinol. Laryngol. 117, 919–924 (2008).

    Article  PubMed  Google Scholar 

  68. Hughes, T. A. & Wiles, C. M. Neurogenic dysphagia: the role of the neurologist. J. Neurol. Neurosurg. Psychiatry 64, 569–572 (1998).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Sapir, S., Ramig, L. & Fox, C. Speech and swallowing disorders in Parkinson disease. Curr. Opin. Otolaryngol. Head Neck Surg. 16, 205–210 (2008).

    Article  PubMed  Google Scholar 

  70. Adams, V., Mathisen, B., Baines, S., Lazarus, C. & Callister, R. A systematic review and meta-analysis of measurements of tongue and hand strength and endurance using the Iowa Oral Performance Instrument (IOPI). Dysphagia 28, 350–369 (2013).

    Article  PubMed  Google Scholar 

  71. McCormack, J., Casey, V., Conway, R., Saunders, J. & Perry, A. OroPress a new wireless tool for measuring oro-lingual pressures: a pilot study in healthy adults. J. Neuroeng. Rehabil. 12, 32 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  72. Schroeder, M. F., Daniels, S. K., McClain, M., Corey, D. M. & Foundas, A. L. Clinical and cognitive predictors of swallowing recovery in stroke. J. Rehabil. Res. Dev. 43, 301–310 (2006).

    Article  PubMed  Google Scholar 

  73. Crary, M. A., Mann, G. D. & Groher, M. E. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch. Phys. Med. Rehabil. 86, 1516–1520 (2005).

    Article  PubMed  Google Scholar 

  74. Mann, G. MASA: the Mann Assessment of Swallowing Ability (Singular, 2002).

    Google Scholar 

  75. Martino, R., Pron, G. & Diamant, N. E. Oropharyngeal dysphagia: surveying practice patterns of the speech-language pathologist. Dysphagia 19, 165–176 (2004).

    Article  PubMed  Google Scholar 

  76. DePippo, K. L., Holas, M. A. & Reding, M. J. Validation of the 3-oz water swallow test for aspiration following stroke. Arch. Neurol. 49, 1259–1261 (1992).

    Article  CAS  PubMed  Google Scholar 

  77. McCullough, G. H. et al. Inter- and intrajudge reliability for videofluoroscopic swallowing evaluation measures. Dysphagia 16, 110–118 (2001).

    Article  CAS  PubMed  Google Scholar 

  78. Daniels, S. K., Ballo, L. A., Mahoney, M. C. & Foundas, A. L. Clinical predictors of dysphagia and aspiration risk: outcome measures in acute stroke patients. Arch. Phys. Med. Rehabil. 81, 1030–1033 (2000).

    Article  CAS  PubMed  Google Scholar 

  79. Lee, J. Y., Kim, D. K., Seo, K. M. & Kang, S. H. Usefulness of the simplified cough test in evaluating cough reflex sensitivity as a screening test for silent aspiration. Ann. Rehabil. Med. 38, 476–484 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  80. Troche, M. S., Brandimore, A. E., Okun, M. S., Davenport, P. W. & Hegland, K. W. Decreased cough sensitivity and aspiration in Parkinson disease. Chest 146, 1294–1299 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  81. Sejdic, E., Dudik, J. M., Kurosu, A., Jestrovic, I. & Coyle, J. L. Understanding differences between healthy swallows and penetration-aspiration swallows via compressive sensing of tri-axial swallowing accelerometry signals. Proc. SPIE Int. Soc. Opt. Eng. 9190, 91090M (2014).

  82. Jestrovic, I., Dudik, J. M., Luan, B., Coyle, J. L. & Sejdic, E. The effects of increased fluid viscosity on swallowing sounds in healthy adults. Biomed. Eng. Online 12, 90 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  83. Sejdic, E., Steele, C. M. & Chau, T. Classification of penetration — aspiration versus healthy swallows using dual-axis swallowing accelerometry signals in dysphagic subjects. IEEE Trans. Biomed. Eng. 60, 1859–1866 (2013).

    Article  PubMed  Google Scholar 

  84. Lee, J., Steele, C. M. & Chau, T. Classification of healthy and abnormal swallows based on accelerometry and nasal airflow signals. Artif. Intell. Med. 52, 17–25 (2011).

    Article  PubMed  Google Scholar 

  85. Hammoudi, K., Boiron, M., Hernandez, N., Bobillier, C. & Morinière, S. Acoustic study of pharyngeal swallowing as a function of the volume and consistency of the bolus. Dysphagia 29, 468–474 (2014).

    Article  PubMed  Google Scholar 

  86. Bergström, L., Svensson, P. & Hartelius, L. Cervical auscultation as an adjunct to the clinical swallow examination: a comparison with fibre-optic endoscopic evaluation of swallowing. Int. J. Speech Lang. Pathol. 16, 517–528 (2014).

    Article  PubMed  Google Scholar 

  87. Crary, M. A., Sura, L. & Carnaby, G. Validation and demonstration of an isolated acoustic recording technique to estimate spontaneous swallow frequency. Dysphagia 28, 86–94 (2013).

    Article  PubMed  Google Scholar 

  88. Youmans, S. R. & Stierwalt, J. A. Normal swallowing acoustics across age, gender, bolus viscosity, and bolus volume. Dysphagia 26, 374–384 (2011).

    Article  PubMed  Google Scholar 

  89. Regan, J., Walshe, M., Timon, C. & McMahon, B. P. Endoflip® evaluation of pharyngo-oesophageal segment tone and swallowing in a clinical population: a total laryngectomy case series. Clin. Otolaryngol. 40, 121–129 (2015).

    Article  CAS  PubMed  Google Scholar 

  90. Regan, J., Walshe, M., Rommel, N., Tack, J. & McMahon, B. P. New measures of upper esophageal sphincter distensibility and opening patterns during swallowing in healthy subjects using EndoFLIP®. Neurogastroenterol. Motil. 25, e25–e34 (2013).

    Article  CAS  PubMed  Google Scholar 

  91. Regan, J., Walshe, M., Rommel, N. & McMahon, B. P. A new evaluation of the upper esophageal sphincter using the functional lumen imaging probe: a preliminary report. Dis. Esophagus 26, 117–123 (2013).

    Article  CAS  PubMed  Google Scholar 

  92. Cook, I. J. Oropharyngeal dysphagia. Gastroenterol. Clin. North Am. 38, 411–431 (2009).

    Article  PubMed  Google Scholar 

  93. Rosenbek, J. C. et al. A penetration-aspiration scale. Dysphagia 11, 93–98 (1996).

    Article  CAS  PubMed  Google Scholar 

  94. Jaffer, N. M., Ng, E., Au, F. W. & Steele, C. M. Fluoroscopic evaluation of oropharyngeal dysphagia: anatomic, technical, and common etiologic factors. AJR Am. J. Roentgenol. 204, 49–58 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  95. Yamamoto, H., Furuya, J., Tamada, Y. & Kondo, H. Impacts of wearing complete dentures on bolus transport during feeding in elderly edentulous. J. Oral Rehabil. 40, 923–931 (2013).

    Article  CAS  PubMed  Google Scholar 

  96. Molfenter, S. M. & Steele, C. M. Variation in temporal measures of swallowing: sex and volume effects. Dysphagia 28, 226–233 (2013).

    Article  PubMed  Google Scholar 

  97. Humbert, I. A. et al. Human hyolaryngeal movements show adaptive motor learning during swallowing. Dysphagia 28, 139–145 (2013).

    Article  PubMed  Google Scholar 

  98. Steele, C. M. et al. The relationship between hyoid and laryngeal displacement and swallowing impairment. Clin. Otolaryngol. 36, 30–36 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  99. Rofes, L. et al. Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol. Motil. 22, 851–858 (2010).

    Article  CAS  PubMed  Google Scholar 

  100. Allen, J. E., White, C. J., Leonard, R. J. & Belafsky, P. C. Prevalence of penetration and aspiration on videofluoroscopy in normal individuals without dysphagia. Otolaryngol. Head Neck Surg. 142, 208–213 (2010).

    Article  PubMed  Google Scholar 

  101. Maffei, C. et al. Videofluoroscopic evaluation of mastication and swallowing in individuals with TMD. Braz. J. Otorhinolaryngol. 78, 24–28 (2012).

    Article  PubMed  Google Scholar 

  102. Leder, S. B., Burrell, M. I. & Van Daele, D. J. Epiglottis is not essential for successful swallowing in humans. Ann. Otol. Rhinol. Laryngol. 119, 795–798 (2010).

    Article  PubMed  Google Scholar 

  103. Kang, B. S. et al. Influence of aging on movement of the hyoid bone and epiglottis during normal swallowing: a motion analysis. Gerontology 56, 474–482 (2010).

    Article  PubMed  Google Scholar 

  104. Stokely, S. L., Molfenter, S. M. & Steele, C. M. Effects of barium concentration on oropharyngeal swallow timing measures. Dysphagia 29, 78–82 (2014).

    Article  PubMed  Google Scholar 

  105. Nagy, A. et al. Timing differences between cued and noncued swallows in healthy young adults. Dysphagia 28, 428–434 (2013).

    Article  PubMed  Google Scholar 

  106. Kim, H. M., Choi, K. H. & Kim, T. W. Patients' radiation dose during videofluoroscopic swallowing studies according to underlying characteristics. Dysphagia 28, 153–158 (2013).

    Article  PubMed  Google Scholar 

  107. Chau, K. H. & Kung, C. M. Patient dose during videofluoroscopy swallowing studies in a Hong Kong public hospital. Dysphagia 24, 387–390 (2009).

    Article  PubMed  Google Scholar 

  108. Kurosu, A. & Logemann, J. A. Gender effects on airway closure in head and neck cancer patients. Dysphagia 26, 18–26 (2011).

    Article  PubMed  Google Scholar 

  109. Umemoto, G. et al. Dysphagia in Duchenne muscular dystrophy versus myotonic dystrophy type 1. Muscle Nerve 46, 490–495 (2012).

    Article  PubMed  Google Scholar 

  110. Almirall, J. et al. Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly. Eur. Respir. J. 41, 923–928 (2013).

    Article  PubMed  Google Scholar 

  111. Warabi, T. et al. Effects of stroke-induced damage to swallow-related areas in the brain on swallowing mechanics of elderly patients. Geriatr. Gerontol. Int. 8, 234–242 (2008).

    Article  PubMed  Google Scholar 

  112. Ford, S., Gollins, S., Hobson, P. & Vyas, S. Structural displacements during the swallow in patients with early laryngeal cancers and other early primary cancers of the head and neck. Dysphagia 24, 127–136 (2009).

    Article  PubMed  Google Scholar 

  113. Narajos, N., Samejima, Y., Kumai, Y. & Yumoto, E. Postdeglutitive residue in idiopathic unilateral vocal fold paralysis: a quantitative videofluoroscopic study. Laryngoscope 123, 2776–2779 (2013).

    Article  PubMed  Google Scholar 

  114. Langdon, P. C., Mulcahy, K., Shepherd, K. L., Low, V. H. & Mastaglia, F. L. Pharyngeal dysphagia in inflammatory muscle diseases resulting from impaired suprahyoid musculature. Dysphagia 27, 408–417 (2012).

    Article  PubMed  Google Scholar 

  115. dos Santos, C. M., Cassiani, R. A. & Dantas, R. O. Videofluoroscopic evaluation of swallowing in Chagas' disease. Dysphagia 26, 361–365 (2011).

    Article  PubMed  Google Scholar 

  116. Troche, M. S., Huebner, I., Rosenbek, J. C., Okun, M. S. & Sapienza, C. M. Respiratory-swallowing coordination and swallowing safety in patients with Parkinson's disease. Dysphagia 26, 218–224 (2011).

    Article  PubMed  Google Scholar 

  117. Hunter, K. U. et al. Aspiration pneumonia chemo-intensity-modulated radiation therapy of oropharyngeal carcinoma and its clinical and dysphagia-related predictors. Head Neck 36, 120–125 (2014).

    Article  PubMed  Google Scholar 

  118. Cvejic, L. et al. Laryngeal penetration and aspiration in individuals with stable COPD. Respirology 16, 269–275 (2011).

    Article  PubMed  Google Scholar 

  119. Gluck, I. et al. Evaluating and reporting dysphagia in trials of chemoirradiation for head-and-neck cancer. Int. J. Radiat. Oncol. Biol. Phys. 77, 727–733 (2010).

    Article  PubMed  Google Scholar 

  120. Falsetti, P. et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J. Stroke Cerebrovasc. Dis. 18, 329–335 (2009).

    Article  PubMed  Google Scholar 

  121. Terré, R. & Mearin, F. Resolution of tracheal aspiration after the acute phase of stroke-related oropharyngeal dysphagia. Am. J. Gastroenterol. 104, 923–932 (2009).

    Article  PubMed  Google Scholar 

  122. Aung, M. S., Goulermas, J. Y., Hamdy, S. & Power, M. Spatiotemporal visualizations for the measurement of oropharyngeal transit time from videofluoroscopy. IEEE Trans. Biomed. Eng. 57, 432–441 (2010).

    Article  PubMed  Google Scholar 

  123. Power, M. L. et al. Predicting aspiration after hemispheric stroke from timing measures of oropharyngeal bolus flow and laryngeal closure. Dysphagia 24, 257–264 (2009).

    Article  PubMed  Google Scholar 

  124. Aung, M. S., Goulermas, J. Y., Stanschus, S., Hamdy, S. & Power, M. Automated anatomical demarcation using an active shape model for videofluoroscopic analysis in swallowing. Med. Eng. Phys. 32, 1170–1179 (2010).

    Article  CAS  PubMed  Google Scholar 

  125. Leonard, R., Rees, C. J., Belafsky, P. & Allen, J. Fluoroscopic surrogate for pharyngeal strength: the pharyngeal constriction ratio (PCR). Dysphagia 26, 13–17 (2011).

    Article  PubMed  Google Scholar 

  126. Lafer, M. et al. Temporal measurements of deglutition in dynamic magnetic resonance imaging versus videofluoroscopy. Ann. Otol. Rhinol. Laryngol. 122, 748–753 (2013).

    Article  PubMed  Google Scholar 

  127. Waito, A., Bailey, G. L., Molfenter, S. M., Zoratto, D. C. & Steele, C. M. Voice-quality abnormalities as a sign of dysphagia: validation against acoustic and videofluoroscopic data. Dysphagia 26, 125–134 (2011).

    Article  PubMed  Google Scholar 

  128. Omari, T. I. et al. Reproducibility and agreement of pharyngeal automated impedance manometry with videofluoroscopy. Clin. Gastroenterol. Hepatol. 9, 862–867 (2011).

    Article  PubMed  Google Scholar 

  129. Schultheiss, C., Schauer, T., Nahrstaedt, H. & Seidl, R. O. Evaluation of an EMG bioimpedance measurement system for recording and analysing the pharyngeal phase of swallowing. Eur. Arch. Otorhinolaryngol. 270, 2149–2156 (2013).

    Article  PubMed  Google Scholar 

  130. Shem, K. L. et al. Diagnostic accuracy of bedside swallow evaluation versus videofluoroscopy to assess dysphagia in individuals with tetraplegia. PMR 4, 283–289 (2012).

    Article  Google Scholar 

  131. Singh, V. et al. Investigation of aspiration: milk nasendoscopy versus videofluoroscopy. Eur. Arch. Otorhinolaryngol. 266, 543–545 (2009).

    Article  CAS  PubMed  Google Scholar 

  132. Stroud, A. E., Lawrie, B. W. & Wiles, C. M. Inter- and intra-rater reliability of cervical auscultation to detect aspiration in patients with dysphagia. Clin. Rehabil. 16, 640–645 (2002).

    Article  CAS  PubMed  Google Scholar 

  133. Colodny, N. Interjudge and intrajudge reliabilities in fiberoptic endoscopic evaluation of swallowing (FEES®) using the penetration-aspiration scale: a replication study. Dysphagia 17, 308–315 (2002).

    Article  PubMed  Google Scholar 

  134. Huang, Y. H. et al. The value of pharyngeal scintigraphy in predicting videofluoroscopic findings. Am. J. Phys. Med. Rehabil. 92, 1075–1083 (2013).

    Article  PubMed  Google Scholar 

  135. Kim, S. J., Han, T. R. & Kwon, T. K. Kinematic analysis of hyolaryngeal complex movement in patients with dysphagia development after pneumonectomy. Thorac. Cardiovasc. Surg. 58, 108–112 (2010).

    Article  CAS  PubMed  Google Scholar 

  136. Rofes, L., Arreola, V., Mukherjee, R., Swanson, J. & Clavé, P. The effects of a xanthan gum-based thickener on the swallowing function of patients with dysphagia. Aliment. Pharmacol. Ther. 39, 1169–1179 (2014).

    Article  CAS  PubMed  Google Scholar 

  137. Zu, Y. et al. Evaluation of swallow function after tongue cancer treatment using real-time magnetic resonance imaging: a pilot study. JAMA Otolaryngol. Head Neck Surg. 139, 1312–1319 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  138. Mannelli, G., Parrinello, G. & Gallo, O. Hypopharyngeal mucosal flap reconstruction in endoscopic supraglottic laryngectomy. Am. J. Otolaryngol. 34, 523–526 (2013).

    Article  PubMed  Google Scholar 

  139. Archontaki, M. et al. Functional results of speech and swallowing after oral microvascular free flap reconstruction. Eur. Arch. Otorhinolaryngol. 267, 1771–1777 (2010).

    Article  PubMed  Google Scholar 

  140. Cola, P. C. et al. The influence of sour taste and cold temperature in pharyngeal transit duration in patients with stroke. Arq. Gastroenterol. 47, 18–21 (2010).

    Article  PubMed  Google Scholar 

  141. Regan, J., Walshe, M. & Tobin, W. O. Immediate effects of thermal-tactile stimulation on timing of swallow in idiopathic Parkinson's disease. Dysphagia 25, 207–215 (2010).

    Article  PubMed  Google Scholar 

  142. Tei, K. et al. Does swallowing function recover in the long term in patients with surgically treated tongue carcinomas? J. Oral Maxillofac. Surg. 70, 2680–2686 (2012).

    Article  PubMed  Google Scholar 

  143. Terré, R. & Mearin, F. Effectiveness of chin-down posture to prevent tracheal aspiration in dysphagia secondary to acquired brain injury. A videofluoroscopy study. Neurogastroenterol. Motil. 24, 414–419 (2012).

    Article  PubMed  Google Scholar 

  144. Sdravou, K., Walshe, M. & Dagdilelis, L. Effects of carbonated liquids on oropharyngeal swallowing measures in people with neurogenic dysphagia. Dysphagia 27, 240–250 (2012).

    Article  PubMed  Google Scholar 

  145. van der Kruis, J. G., Baijens, L. W., Speyer, R. & Zwijnenberg, I. Biomechanical analysis of hyoid bone displacement in videofluoroscopy: a systematic review of intervention effects. Dysphagia 26, 171–182 (2011).

    Article  PubMed  Google Scholar 

  146. Ozgursoy, O. B. & Salassa, J. R. Manofluorographic and functional outcomes after endoscopic laser cricopharyngeal myotomy for cricopharyngeal bar. Otolaryngol. Head Neck Surg. 142, 735–740 (2010).

    Article  PubMed  Google Scholar 

  147. Baylow, H. E., Goldfarb, R., Taveira, C. H. & Steinberg, R. S. Accuracy of clinical judgment of the chin-down posture for dysphagia during the clinical/bedside assessment as corroborated by videofluoroscopy in adults with acute stroke. Dysphagia 24, 423–433 (2009).

    Article  PubMed  Google Scholar 

  148. Langmore, S. E. et al. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia 13, 69–81 (1998).

    Article  CAS  PubMed  Google Scholar 

  149. Baijens, L., Barikroo, A. & Pilz, W. Intrarater and interrater reliability for measurements in videofluoroscopy of swallowing. Eur. J. Radiol. 82, 1683–1695 (2013).

    Article  PubMed  Google Scholar 

  150. Nativ-Zeltzer, N., Kahrilas, P. J. & Logemann, J. A. Manofluorography in the evaluation of oropharyngeal dysphagia. Dysphagia 27, 151–161 (2012).

    Article  PubMed  Google Scholar 

  151. Langmore, S. E. & Aviv, J. E. Endoscopic Evaluation and Treatment of Swallowing Disorders (Thieme, 2000).

    Google Scholar 

  152. Hiss, S. G. & Postma, G. N. Fiberoptic endoscopic evaluation of swallowing. Laryngoscope 113, 1386–1393 (2003).

    Article  PubMed  Google Scholar 

  153. Langmore, S. E., Schatz, K. & Olsen, N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 2, 216–219 (1988).

    Article  CAS  PubMed  Google Scholar 

  154. Butler, S. G., Markley, L., Sanders, B. & Stuart, A. Reliability of the penetration aspiration scale with flexible endoscopic evaluation of swallowing. Ann. Otol. Rhinol. Laryngol. 124, 480–483 (2015).

    Article  PubMed  Google Scholar 

  155. Kaneoka, A. S. et al. The Boston residue and clearance scale: preliminary reliability and validity testing. Folia Phoniatr. Logop. 65, 312–317 (2013).

    Article  PubMed  Google Scholar 

  156. Brady, S. & Donzelli, J. The modified barium swallow and the functional endoscopic evaluation of swallowing. Otolaryngol. Clin. North Am. 46, 1009–1022 (2013).

    Article  PubMed  Google Scholar 

  157. Langmore, S. E. Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior? Curr. Opin. Otolaryngol. Head Neck Surg. 11, 485–489 (2003).

    Article  PubMed  Google Scholar 

  158. Baijens, L. W., Speyer, R., Pilz, W. & Roodenburg, N. FEES protocol derived estimates of sensitivity: aspiration in dysphagic patients. Dysphagia 29, 583–590 (2014).

    Article  PubMed  Google Scholar 

  159. Dziewas, R. et al. Towards a basic endoscopic assessment of swallowing in acute stroke—development and evaluation of a simple dysphagia score. Cerebrovasc. Dis. 26, 41–47 (2008).

    Article  PubMed  Google Scholar 

  160. Aviv, J. E., Murry, T., Zschommler, A., Cohen, M. & Gartner, C. Flexible endoscopic evaluation of swallowing with sensory testing: patient characteristics and analysis of safety in 1,340 consecutive examinations. Ann. Otol. Rhinol. Laryngol. 114, 173–176 (2005).

    Article  PubMed  Google Scholar 

  161. Aviv, J. E., Martin, J. H., Keen, M. S., Debell, M. & Blitzer, A. Air pulse quantification of supraglottic and pharyngeal sensation: a new technique. Ann. Otol. Rhinol. Laryngol. 102, 777–780 (1993).

    Article  CAS  PubMed  Google Scholar 

  162. Aviv, J. E. et al. Laryngopharyngeal sensory discrimination testing and the laryngeal adductor reflex. Ann. Otol. Rhinol. Laryngol. 108, 725–730 (1999).

    Article  CAS  PubMed  Google Scholar 

  163. Leder, S. B., Acton, L. M., Lisitano, H. L. & Murray, J. T. Fiberoptic endoscopic evaluation of swallowing (FEES) with and without blue-dyed food. Dysphagia 20, 157–162 (2005).

    Article  PubMed  Google Scholar 

  164. Badenduck, L. A. et al. Fiber-optic endoscopic evaluation of swallowing to assess swallowing outcomes as a function of head position in a normal population. J. Otolaryngol. Head Neck Surg. 43, 9 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  165. Butler, S. G. et al. Effects of liquid type, delivery method, and bolus volume on penetration-aspiration scores in healthy older adults during flexible endoscopic evaluation of swallowing. Ann. Otol. Rhinol. Laryngol. 120, 288–295 (2011).

    Article  PubMed  Google Scholar 

  166. Schultheiss, C., Nusser-Müller-Busch, R. & Seidl, R. O. The semisolid bolus swallow test for clinical diagnosis of oropharyngeal dysphagia: a prospective randomised study. Eur. Arch. Otorhinolaryngol. 268, 1837–1844 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  167. Kelly, A. M., Leslie, P., Beale, T., Payten, C. & Drinnan, M. J. Fibreoptic endoscopic evaluation of swallowing and videofluoroscopy: does examination type influence perception of pharyngeal residue severity? Clin. Otolaryngol. 31, 425–432 (2006).

    Article  CAS  PubMed  Google Scholar 

  168. Thottam, P. J., Silva, R. C., McLevy, J. D., Simons, J. P. & Mehta, D. K. Use of fiberoptic endoscopic evaluation of swallowing (FEES) in the management of psychogenic dysphagia in children. Int. J. Pediatr. Otorhinolaryngol. 79, 108–110 (2015).

    Article  PubMed  Google Scholar 

  169. Butler, S. G., Stuart, A., Markley, L. & Rees, C. Penetration and aspiration in healthy older adults as assessed during endoscopic evaluation of swallowing. Ann. Otol. Rhinol. Laryngol. 118, 190–198 (2009).

    Article  PubMed  Google Scholar 

  170. Osborn, A. J. et al. Swallowing function after laryngeal cleft repair: more than just fixing the cleft. Laryngoscope 124, 1965–1969 (2014).

    Article  PubMed  Google Scholar 

  171. Leder, S. B., Joe, J. K., Hill, S. E. & Traube, M. Effect of tracheotomy tube occlusion on upper esophageal sphincter and pharyngeal pressures in aspirating and nonaspirating patients. Dysphagia 16, 79–82 (2001).

    Article  CAS  PubMed  Google Scholar 

  172. McGowan, S. L., Gleeson, M., Smith, M., Hirsch, N. & Shuldham, C. M. A pilot study of fibreoptic endoscopic evaluation of swallowing in patients with cuffed tracheostomies in neurological intensive care. Neurocrit. Care 6, 90–93 (2007).

    Article  PubMed  Google Scholar 

  173. Clayton, N. A., Carnaby, G. D., Peters, M. J. & Ing, A. J. Impaired laryngopharyngeal sensitivity in patients with COPD: the association with swallow function. Int. J. Speech Lang. Pathol. 16, 615–623 (2014).

    Article  PubMed  Google Scholar 

  174. Patterson, M. et al. Functional swallowing outcomes in nasopharyngeal cancer treated with IMRT at 6 to 42 months post-radiotherapy. Dysphagia 29, 663–670 (2014).

    Article  PubMed  Google Scholar 

  175. Leder, S. B. & Espinosa, J. F. Aspiration risk after acute stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing. Dysphagia 17, 214–218 (2002).

    Article  PubMed  Google Scholar 

  176. Somasundaram, S. et al. Dysphagia risk assessment in acute left-hemispheric middle cerebral artery stroke. Cerebrovasc. Dis. 37, 217–222 (2014).

    Article  PubMed  Google Scholar 

  177. Warnecke, T. et al. Assessment of aspiration risk in acute ischaemic stroke — evaluation of the simple swallowing provocation test. J. Neurol. Neurosurg. Psychiatry 79, 312–314 (2008).

    Article  CAS  PubMed  Google Scholar 

  178. Warnecke, T. et al. Endoscopic characteristics and levodopa responsiveness of swallowing function in progressive supranuclear palsy. Mov. Disord. 25, 1239–1245 (2010).

    Article  PubMed  Google Scholar 

  179. Brady, S. L., Pape, T. L., Darragh, M., Escobar, N. G. & Rao, N. Feasibility of instrumental swallowing assessments in patients with prolonged disordered consciousness while undergoing inpatient rehabilitation. J. Head Trauma Rehabil. 24, 384–391 (2009).

    Article  PubMed  Google Scholar 

  180. Lim, S. H. et al. Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients. Dysphagia 16, 1–6 (2001).

    Article  CAS  PubMed  Google Scholar 

  181. Kelly, A. M., Drinnan, M. J. & Leslie, P. Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare? Laryngoscope 117, 1723–1727 (2007).

    Article  PubMed  Google Scholar 

  182. Olthoff, A., Zhang, S., Schweizer, R. & Frahm, J. On the physiology of normal swallowing as revealed by magnetic resonance imaging in real time. Gastroenterol. Res. Pract. 2014, 493174 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  183. Rommel, N. & Omari, T. Manual of High Resolution Esophageal Manometry (UNI-MED, 2014).

    Google Scholar 

  184. Ghosh, S. K., Pandolfino, J. E., Zhang, Q., Jarosz, A. & Kahrilas, P. J. Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry. Am. J. Physiol. Gastrointest. Liver Physiol. 291, G525–G531 (2006).

    Article  CAS  PubMed  Google Scholar 

  185. Dire, C., Shi, G., Manka, M. & Kahrilas, P. J. Manometric characteristics of the upper esophageal sphincter recorded with a microsleeve. Am. J. Gastroenterol. 96, 1383–1389 (2001).

    Article  CAS  PubMed  Google Scholar 

  186. Kahrilas, P. J., Logemann, J. A., Krugler, C. & Flanagan, E. Volitional augmentation of upper esophageal sphincter opening during swallowing. Am. J. Physiol. 260, G450–G456 (1991).

    CAS  PubMed  Google Scholar 

  187. Kahrilas, P. J., Dodds, W. J., Dent, J., Logemann, J. A. & Shaker, R. Upper esophageal sphincter function during deglutition. Gastroenterology 95, 52–62 (1988).

    Article  CAS  PubMed  Google Scholar 

  188. Kahrilas, P. J., Dent, J., Dodds, W. J., Hogan, W. J. & Arndorfer, R. C. A method for continuous monitoring of upper esophageal sphincter pressure. Dig. Dis. Sci. 32, 121–128 (1987).

    Article  CAS  PubMed  Google Scholar 

  189. Pouderoux, P. & Kahrilas, P. J. Function of upper esophageal sphincter during swallowing: the grabbing effect. Am. J. Physiol. 272, G1057–G1063 (1997).

    CAS  PubMed  Google Scholar 

  190. Lee, C. T., Chang, F. Y., Yeh, C. L. & Lee, S. D. Radial asymmetry characterized the upper esophageal sphincter pressures. Chin. J. Physiol. 37, 225–228 (1994).

    CAS  PubMed  Google Scholar 

  191. Silva, L. C. et al. Anatomophysiology of the pharyngo-upper esophageal area in light of high-resolution manometry. J. Gastrointest. Surg. 17, 2033–2038 (2013).

    Article  PubMed  Google Scholar 

  192. Lee, T. H. et al. High-resolution impedance manometry facilitates assessment of pharyngeal residue and oropharyngeal dysphagic mechanisms. Dis. Esophagus 27, 220–229 (2014).

    Article  CAS  PubMed  Google Scholar 

  193. Kessing, B. F., Bredenoord, A. J. & Smout, A. J. Mechanisms of gastric and supragastric belching: a study using concurrent high-resolution manometry and impedance monitoring. Neurogastroenterol. Motil. 24, e573–e579 (2012).

    Article  CAS  PubMed  Google Scholar 

  194. Amaris, M., Dua, K. S., Naini, S. R., Samuel, E. & Shaker, R. Characterization of the upper esophageal sphincter response during cough. Chest 142, 1229–1236 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  195. Hernandez, L. V., Dua, K. S., Surapaneni, S. N., Rittman, T. & Shaker, R. Anatomic-manometric correlation of the upper esophageal sphincter: a concurrent US and manometry study. Gastrointest. Endosc. 72, 587–592 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  196. Babaei, A. et al. Response of the upper esophageal sphincter to esophageal distension is affected by posture, velocity, volume, and composition of the infusate. Gastroenterology 142, 734–743.e7 (2012).

    Article  PubMed  Google Scholar 

  197. Castell, J. A., Dalton, C. B. & Castell, D. O. Effects of body position and bolus consistency on the manometric parameters and coordination of the upper esophageal sphincter and pharynx. Dysphagia 5, 179–186 (1990).

    Article  CAS  PubMed  Google Scholar 

  198. Dejaeger, E., Pelemans, W., Ponette, E. & Vantrappen, G. Effect of body position on deglutition. Dig. Dis. Sci. 39, 762–765 (1994).

    Article  CAS  PubMed  Google Scholar 

  199. Balou, M. et al. Manometric measures of head rotation and chin tuck in healthy participants. Dysphagia 29, 25–32 (2014).

    Article  PubMed  Google Scholar 

  200. Castell, J. A., Castell, D. O., Schultz, A. R. & Georgeson, S. Effect of head position on the dynamics of the upper esophageal sphincter and pharynx. Dysphagia 8, 1–6 (1993).

    Article  CAS  PubMed  Google Scholar 

  201. Takasaki, K., Umeki, H., Kumagami, H. & Takahashi, H. Influence of head rotation on upper esophageal sphincter pressure evaluated by high-resolution manometry system. Otolaryngol. Head Neck Surg. 142, 214–217 (2010).

    Article  PubMed  Google Scholar 

  202. Dantas, R. O. et al. Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing. Am. J. Physiol. 258, G675–G681 (1990).

    CAS  PubMed  Google Scholar 

  203. Lin, T. et al. Effect of bolus volume on pharyngeal swallowing assessed by high-resolution manometry. Physiol. Behav. 128, 46–51 (2014).

    Article  CAS  PubMed  Google Scholar 

  204. Hoffman, M. R., Ciucci, M. R., Mielens, J. D., Jiang, J. J. & McCulloch, T. M. Pharyngeal swallow adaptations to bolus volume measured with high-resolution manometry. Laryngoscope 120, 2367–2373 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  205. Omari, T. I., Dejaeger, E., Tack, J., Van Beckevoort, D. & Rommel, N. Effect of bolus volume and viscosity on pharyngeal automated impedance manometry variables derived for broad dysphagia patients. Dysphagia 28, 146–152 (2013).

    Article  PubMed  Google Scholar 

  206. Doeltgen, S. H., Macrae, P. & Huckabee, M. L. Pharyngeal pressure generation during tongue-hold swallows across age groups. Am. J. Speech Lang. Pathol. 20, 124–130 (2011).

    Article  PubMed  Google Scholar 

  207. Ren, J. et al. Deterioration of the pharyngo-UES contractile reflex in the elderly. Laryngoscope 110, 1563–1566 (2000).

    Article  CAS  PubMed  Google Scholar 

  208. Yokoyama, M., Mitomi, N., Tetsuka, K., Tayama, N. & Niimi, S. Role of laryngeal movement and effect of aging on swallowing pressure in the pharynx and upper esophageal sphincter. Laryngoscope 110, 434–439 (2000).

    Article  CAS  PubMed  Google Scholar 

  209. Kern, M. et al. Comparison of upper esophageal sphincter opening in healthy asymptomatic young and elderly volunteers. Ann. Otol. Rhinol. Laryngol. 108, 982–989 (1999).

    Article  CAS  PubMed  Google Scholar 

  210. Shaw, D. W. et al. Influence of normal aging on oral-pharyngeal and upper esophageal sphincter function during swallowing. Am. J. Physiol. 268, G389–G396 (1995).

    Article  CAS  PubMed  Google Scholar 

  211. Ren, J. et al. Effect of age and bolus variables on the coordination of the glottis and upper esophageal sphincter during swallowing. Am. J. Gastroenterol. 88, 665–669 (1993).

    CAS  PubMed  Google Scholar 

  212. Robbins, J., Hamilton, J. W., Lof, G. L. & Kempster, G. B. Oropharyngeal swallowing in normal adults of different ages. Gastroenterology 103, 823–829 (1992).

    Article  CAS  PubMed  Google Scholar 

  213. Fulp, S. R., Dalton, C. B., Castell, J. A. & Castell, D. O. Aging-related alterations in human upper esophageal sphincter function. Am. J. Gastroenterol. 85, 1569–1572 (1990).

    CAS  PubMed  Google Scholar 

  214. Wilson, J. A., Pryde, A., Macintyre, C. C., Maran, A. G. & Heading, R. C. The effects of age, sex, and smoking on normal pharyngoesophageal motility. Am. J. Gastroenterol. 85, 686–691 (1990).

    CAS  PubMed  Google Scholar 

  215. Omari, T. I. et al. Swallowing dysfunction in healthy older people using pharyngeal pressure-flow analysis. Neurogastroenterol. Motil. 26, 59–68 (2014).

    Article  CAS  PubMed  Google Scholar 

  216. Bodén, K., Hallgren, A. & Witt Hedström, H. Effects of three different swallow maneuvers analyzed by videomanometry. Acta Radiol. 47, 628–633 (2006).

    Article  PubMed  Google Scholar 

  217. Kwiatek, M. A., Mirza, F., Kahrilas, P. J. & Pandolfino, J. E. Hyperdynamic upper esophageal sphincter pressure: a manometric observation in patients reporting globus sensation. Am. J. Gastroenterol. 104, 289–298 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  218. Peng, L., Patel, A., Kushnir, V. & Gyawali, C. P. Assessment of upper esophageal sphincter function on high-resolution manometry: identification of predictors of globus symptoms. J. Clin. Gastroenterol. 49, 95–100 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  219. Choi, W. S. et al. High-resolution manometry and globus: comparison of globus, gastroesophageal reflux disease and normal controls using high-resolution manometry. J. Neurogastroenterol. Motil. 19, 473–478 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  220. Vakil, N. B., Kahrilas, P. J., Dodds, W. J. & Vanagunas, A. Absence of an upper esophageal sphincter response to acid reflux. Am. J. Gastroenterol. 84, 606–610 (1989).

    CAS  PubMed  Google Scholar 

  221. Vardar, R., Sweis, R., Anggiansah, A., Wong, T. & Fox, M. R. Upper esophageal sphincter and esophageal motility in patients with chronic cough and reflux: assessment by high-resolution manometry. Dis. Esophagus 26, 219–225 (2013).

    Article  CAS  PubMed  Google Scholar 

  222. Szczesniak, M. M. et al. Upregulation of the esophago-UES relaxation response: a possible pathophysiological mechanism in suspected reflux laryngitis. Neurogastroenterol. Motil. 22, 381–386 (2010).

    Article  CAS  PubMed  Google Scholar 

  223. Mathews, S. C. et al. Upper esophageal sphincter abnormalities are strongly predictive of treatment response in patients with achalasia. World J. Clin. Cases 2, 448–454 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  224. Wauters, L. et al. Balloon dilation of the esophago-gastric junction affects lower and upper esophageal sphincter function in achalasia. Neurogastroenterol. Motil. 26, 69–76 (2014).

    Article  CAS  PubMed  Google Scholar 

  225. Chavez, Y. H. et al. Upper esophageal sphincter abnormalities: frequent finding on high-resolution esophageal manometry and associated with poorer treatment response in achalasia. J. Clin. Gastroenterol. 49, 17–23 (2015).

    Article  CAS  PubMed  Google Scholar 

  226. Wilson, J. A., Pryde, A., White, A., Maher, L. & Maran, A. G. Swallowing performance in patients with vocal fold motion impairment. Dysphagia 10, 149–154 (1995).

    Article  CAS  PubMed  Google Scholar 

  227. Lan, Y. et al. The correlation between manometric and videofluoroscopic measurements of the swallowing function in brainstem stroke patients with dysphagia. J. Clin. Gastroenterol. 49, 24–30 (2015).

    Article  CAS  PubMed  Google Scholar 

  228. Lan, Y. et al. Biomechanical changes in the pharynx and upper esophageal sphincter after modified balloon dilatation in brainstem stroke patients with dysphagia. Neurogastroenterol. Motil. 25, e821–e829 (2013).

    Article  CAS  PubMed  Google Scholar 

  229. Williams, R. B., Wallace, K. L., Ali, G. N. & Cook, I. J. Biomechanics of failed deglutitive upper esophageal sphincter relaxation in neurogenic dysphagia. Am. J. Physiol. Gastrointest. Liver Physiol. 283, G16–G26 (2002).

    Article  CAS  PubMed  Google Scholar 

  230. Kuhn, M. A. & Belafsky, P. C. Management of cricopharyngeus muscle dysfunction. Otolaryngol. Clin. North Am. 46, 1087–1099 (2013).

    Article  PubMed  Google Scholar 

  231. Jungheim, M., Janhsen, A. M., Miller, S. & Ptok, M. Impact of neuromuscular electrical stimulation on upper esophageal sphincter dynamics: a high-resolution manometry study. Ann. Otol. Rhinol. Laryngol. 124, 5–12 (2015).

    Article  PubMed  Google Scholar 

  232. Terré, R., Panadés, A. & Mearin, F. Botulinum toxin treatment for oropharyngeal dysphagia in patients with stroke. Neurogastroenterol. Motil. 25, e896–e702 (2013).

    Article  CAS  Google Scholar 

  233. Kelly, E. A. et al. Botulinum toxin injection for the treatment of upper esophageal sphincter dysfunction. Ann. Otol. Rhinol. Laryngol. 122, 100–108 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  234. Knauer, C. M., Castell, J. A., Dalton, C. B., Nowak, L. & Castell, D. O. Pharyngeal/upper esophageal sphincter pressure dynamics in humans. Effects of pharmacologic agents and thermal stimulation. Dig. Dis. Sci. 35, 774–780 (1990).

    Article  CAS  PubMed  Google Scholar 

  235. Massey, B. T. Manual of Diagnostic and Therapeutic Techniques for Disorders of Deglutition (Springer, 2013).

    Google Scholar 

  236. Omari, T. I. et al. A method to objectively assess swallow function in adults with suspected aspiration. Gastroenterology 140, 1454–1463 (2011).

    Article  PubMed  Google Scholar 

  237. Omari, T. I. et al. A novel method for the nonradiological assessment of ineffective swallowing. Am. J. Gastroenterol. 106, 1796–1802 (2011).

    Article  PubMed  Google Scholar 

  238. Noll, L., Rommel, N., Davidson, G. P. & Omari, T. I. Pharyngeal flow interval: a novel impedance based parameter correlating with aspiration. Neurogastroenterol. Motil. 23, 551–e206 (2011).

    Article  CAS  PubMed  Google Scholar 

  239. Ferris, L. et al. Pressure flow analysis in the assessment of preswallow pharyngeal bolus presence in dysphagia. Int. J. Otolaryngol. 2015, 764709 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  240. Omari, T. I., Dejaeger, E., Tack, J., Vanbeckevoort, D. & Rommel, N. An impedance-manometry based method for non-radiological detection of pharyngeal postswallow residue. Neurogastroenterol. Motil. 24, e277–e284 (2012).

    Article  CAS  PubMed  Google Scholar 

  241. Omari, T. I. et al. Upper esophageal sphincter impedance as a marker of sphincter opening diameter. Am. J. Physiol. Gastrointest. Liver Physiol. 302, G909–G913 (2012).

    Article  CAS  PubMed  Google Scholar 

  242. Hoffman, M. R. et al. Artificial neural network classification of pharyngeal high-resolution manometry with impedance data. Laryngoscope 123, 713–720 (2013).

    Article  PubMed  Google Scholar 

  243. Omari, T. I. et al. Upper esophageal sphincter mechanical states analysis: a novel methodology to describe UES relaxation and opening. Front. Syst. Neurosci. 8, 241 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  244. McMahon, B. et al. A new technique for evaluating sphincter function in visceral organs: application of the functional lumen imaging probe (FLIP) for the evaluation of the oesophago–gastric junction. Physiol. Meas. 26, 823–836 (2005).

    Article  CAS  PubMed  Google Scholar 

  245. McMahon, B. P. et al. The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction. Am. J. Physiol. Gastrointest. Liver Physiol. 292, G377–G384 (2007).

    Article  CAS  PubMed  Google Scholar 

  246. McMahon, B., Frøkjaer, J. B., Drewes, A. M. & Gregersen, H. A new measurement of oesophago-gastric junction competence. Neurogastroenterol. Motil. 16, 543–546 (2004).

    Article  CAS  PubMed  Google Scholar 

  247. Kunwald, P. et al. A new distensibility technique to measure sphincter of Oddi function. Neurogastroenterol. Motil. 22, 978–983 (2010).

    Article  CAS  PubMed  Google Scholar 

  248. Kwiatek, M. A. et al. Mechanical properties of the esophagus in eosinophilic esophagitis. Gastroenterology 140, 82–90 (2011).

    Article  PubMed  Google Scholar 

  249. Selley, W. G., Ellis, R. E., Flack, F. C., Bayliss, C. R. & Pearce, V. R. The synchronization of respiration and swallow sounds with videofluoroscopy during swallowing. Dysphagia 9, 162–167 (1994).

    Article  CAS  PubMed  Google Scholar 

  250. Reynolds, E. W., Vice, F. L., Bosma, J. F. & Gewolb, I. H. Cervical accelerometry in preterm infants. Dev. Med. Child Neurol. 44, 587–592 (2002).

    Article  PubMed  Google Scholar 

  251. Sejdic, E., Steele, C. M. & Chau, T. A procedure for denoising dual-axis swallowing accelerometry signals. Physiol. Meas. 31, N1–N9 (2010).

    Article  PubMed  Google Scholar 

  252. Lee, J., Sejdic, E., Steele, C. M. & Chau, T. Effects of liquid stimuli on dual-axis swallowing accelerometry signals in a healthy population. Biomed. Eng. Online 9, 7 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  253. Hanna, F., Molfenter, S. M., Cliffe, R. E., Chau, T. & Steele, C. M. Anthropometric and demographic correlates of dual-axis swallowing accelerometry signal characteristics: a canonical correlation analysis. Dysphagia 25, 94–103 (2010).

    Article  PubMed  Google Scholar 

  254. Dudik, J. M., Kurosu, A., Coyle, J. L. & Sejdic, E. A comparative analysis of DBSCAN, K-means, and quadratic variation algorithms for automatic identification of swallows from swallowing accelerometry signals. Comput. Biol. Med. 59, 10–18 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  255. Lee, J., Steele, C. M. & Chau, T. Swallow segmentation with artificial neural networks and multi-sensor fusion. Med. Eng. Phys. 31, 1049–1055 (2009).

    Article  PubMed  Google Scholar 

  256. Steele, C. M., Sejdic, E. & Chau, T. Noninvasive detection of thin-liquid aspiration using dual-axis swallowing accelorometry. Dysphagia 28, 105–112 (2013).

    Article  PubMed  Google Scholar 

  257. Nikjoo, M. S., Steele, C. M., Sejdic, E. & Chau, T. Automatic discrimination between safe and unsafe swallowing using a reputation-based classifier. Biomed. Eng. Online 10, 100 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  258. Merey, C., Kushki, A., Sejdic, E., Berall, G. & Chau, T. Quantitative classification of pediatric swallowing through accelerometry. J. Neuroeng. Rehabil. 9, 34 (2012).

    Article  PubMed  Google Scholar 

  259. Lee, J. et al. A radial basis classifier for the automatic detection of aspiration in children with dysphagia. J. Neuroeng. Rehabil. 3, 14 (2006).

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank E. Michou for her advice and contributions to the manifestations section of this manuscript. We would also like to thank C. Borgers for her technical support for the manuscript.

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Authors and Affiliations

  1. Department of Neurosciences, KU Leuven, Experimental Otorhinolaryngology, Leuven, B-3000, Belgium

    Nathalie Rommel

  2. Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Clinical Sciences Building, Salford Royal Hospital, Eccles Old Road, Salford, M6 8HD, UK

    Shaheen Hamdy

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The authors contributed equally to all aspects in the production of this article.

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Correspondence to Nathalie Rommel.

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Competing interests

N.R. has a patent on Automated Impedance Manometry technology. S.H. is a scientific officer for Phagenesis, which focuses on therapy for dysphagia, but has no competing interests related to this manuscript

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Rommel, N., Hamdy, S. Oropharyngeal dysphagia: manifestations and diagnosis. Nat Rev Gastroenterol Hepatol 13, 49–59 (2016). https://doi.org/10.1038/nrgastro.2015.199

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