Assessing Hyolaryngeal Excursion: Comparing Quantitative Methods to Palpation at the Bedside and Visualization During Vi
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ORIGINAL ARTICLE
Assessing Hyolaryngeal Excursion: Comparing Quantitative Methods to Palpation at the Bedside and Visualization During Videofluoroscopy Danielle Brates1,2
•
Sonja M. Molfenter1 • Susan L. Thibeault2
Received: 26 March 2018 / Accepted: 17 July 2018 Ó Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Purpose Hyolaryngeal excursion (HE) is typically assessed via palpation during clinical swallowing exams (CSE) or visually during videofluoroscopy (VFSS). Minimal evidence exists to support the use of these perceptual methods for judging HE. We investigated whether binary judgment of HE differentiates quantitative measures of hyoid movement, using frame-by-frame VFSS analysis to measure anatomically scaled peak hyoid positions. Methods Medical records of patients who received a CSE and VFSS within a 24-h period were reviewed. Clinician ratings of HE (‘reduced’ or ‘normal’) were collected from CSE and VFSS reports, along with rater experience. Five ml puree swallows were extracted from each VFSS for randomized, blinded analysis. Peak hyoid position from C4 was captured in anterior, superior, and hypotenuse positions and expressed relative to C2–C4 length. T-test comparisons of hyoid positions between patients judged to have reduced versus normal HE on palpation and VFSS were conducted. Results Eighty-seven patients (56 male, mean age 61) met criteria. Peak anterior hyoid position was significantly different between patients judged to have reduced (mean = 89.2% C2–C4) and normal (mean = 110.6% C2–C4) HE on palpation (p = 0.001). Further analysis revealed no effect of clinician experience on differentiation of objective measures based on palpation. No differences were found across any objective measures when compared to clinician VFSS ratings. Conclusions Clinicians appeared to be able to differentiate peak anterior hyoid movement but not superior or hypotenuse movement on palpation. On VFSS visualization, no significant differences were found between swallows judged to have reduced versus normal HE in any directional dimension. While perceptual methods may contribute to clinical decisionmaking, clinicians should remain cautious when making judgments about HE using these methods. Keywords Dysphagia Deglutition Deglutition disorders Hyolaryngeal excursion Palpation Clinical swallowing evaluation
Introduction & Susan L. Thibeault [email protected] Danielle Brates [email protected] Sonja M. Molfenter [email protected] 1
Department of Communicative Sciences and Disorders, NYU Steinhardt, 665 Broadway, 9th Floor, New York, NY 10012, USA
2
Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Wisconsin Institutes for Medical Research (WIMR), BLDG. 1485, 1111 Highland Avenue, Madison, WI 53705-2275, USA
During a normal swallow, contraction of the suprahyoid muscles results in anterior and superior movement of the hyoid bone and larynx [1]. This movement displaces the
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