Evaluation of swallowing ability using swallowing sounds in maxillectomy patients

Abstract

Maxillectomy for oral tumours often results in debilitating oral hypofunction, which markedly decreases quality of life. Dysphagia, in particular, is one of the most serious problems following maxillectomy. This study used swallowing sounds as a simple evaluation method to evaluate swallowing ability in maxillectomy patients with and without their obturator prosthesis placed. Twenty-seven maxillectomy patients (15 men, 12 women; mean age 66.0 ± 12.1 years) and 30 healthy controls (14 men, 16 women; mean age 44.9 ± 21.3 years) were recruited for this study. Participants were asked to swallow 4 mL of water, and swallowing sounds were recorded using a throat microphone. Duration of the acoustic signal and duration of peak intensity (DPI) were measured. Duration of peak intensity was significantly longer in maxillectomy patients without their obturator than with it (P < .05) and was significantly longer in maxillectomy patients without their obturator than in healthy controls (P < .025 after Bonferroni correction). With the obturator placed, DPI was significantly longer in maxillectomy patients who had undergone soft palate resection than in those who had not (P < .05). These results suggest swallowing ability in maxillectomy patients could be improved by wearing an obturator prosthesis, particularly during the oral stage. However, it is difficult to improve the oral stage of swallowing in patients who have undergone soft palate resection even with obturator placement.

Real‐time assessment of swallowing sound using an electronic stethoscope and an artificial intelligence system

“…In our preliminary pilot study, we obtained sampling sounds at several different sites, including the lateral side of the cricoid cartilage and above the sternocleidomastoid muscle, but the analysis was affected by noise generated by friction between the skin or clothes and the electronic stethoscope during swallowing movements. Similar noise may have affected analyses in previous studies using laryngeal microphones (Jayatilake et al, 2015;Kamiyanagi et al, 2018). The sternal notch is a good landmark and serves as a stable site for auscultation, and this may be a factor in the relative stability of measurements from recordings made with the electronic stethoscope at the top of the sternum compared with the results of previous studies using recordings made with a laryngeal microphone at the side of the neck.…”

“…Several similar previous studies also evaluated swallowing sounds using a microphone and analyzed their wavelengths, sound pressure, and duration using acoustic analysis software to assess swallowing function; however, research on swallowing sounds has been somewhat unclear; there is a lack of studies on quantitative swallowing strength change assessments due to factors such as sex and posture (Jayatilake et al, 2015; Kamiyanagi et al, 2018). However, we combined the INDEX and swallowing sound pressure (RMS) to compare differences between sexes, postures, and liquid volumes and found that differences in the INDEX were detected between sexes and postures (Figure 4).…”

“…Many recent studies have therefore attempted to utilize additional instruments, such as microphones and accelerometers, to evaluate swallowing function and conduct acoustic analyses based on swallowing vibration data (Dudik et al, 2018). Although previous studies measured the number and duration of swallowing sounds, they did not quantitatively assess swallowing strength parameters (Jayatilake et al, 2015; Kamiyanagi et al, 2018). In this study, we combined electronic stethoscope techniques with artificial intelligence (AI) to assemble a system that incorporated sound recognition, with the aim of quantifying swallowing sound.…”

Nutritional assessment in a maxillectomy patient from the preoperative period to definitive obturator insertion: A case report

“…It is possible to provide an immediate surgical obturator in collaboration not only with oral, head and neck, and plastic surgeons in the same hospital, but also with other hospitals [10]. A notable and useful point is to provide an immediate surgical obturator, reduce contamination of the surgical wound, and enable relatively normal speech [11] and swallowing [12] in the immediate postoperative period. It is also advantageous because wearing an immediate surgical obturator shortens the period of tube feeding and enables early initiation of oral nutrition [13].…”

A Retrospective Cross-Sectional Analyses of Swallowing and Tongue Functions in Maxillectomy Patients

“…Swallowing is equally important for well-nutrition, whereas it must be an extremely complex neuromuscular process [11,12]. In maxillectomy patients, swallowing is often impaired by resection and radiotherapy [13][14][15][16] and previous studies evaluated the effect of maxillofacial prostheses on swallowing after maxillectomy [16][17][18][19][20][21][22], although functional impacts of maxillofacial prostheses remain controversial because multiple variables are related to swallowing. However, it is obvious that tongue functions play a crucial role in swallowing, especially during oral and pharyngeal phase [23][24][25][26].…”