Effectiveness of Chin Tuck on Laryngeal Penetration: Quantitative Assessment

Abstract

The effectiveness of the chin tuck maneuver is still controversial, despite being widely used in clinical practice. The chin tuck maneuver has been shown to be able to reduce or eliminate aspiration in a group of patients with a number of favorable conditions, but its effectiveness in preventing or managing penetration remains unclear. This study was designed to investigate whether the chin tuck maneuver is effective in reducing penetration. Images from a videofluoroscopic swallowing study (VFSS) taken from 76 patients with penetration were collected and reviewed retrospectively. The severity of penetration was assessed by the penetration ratio (ratio of the penetration depth to the length of the epiglottis) measured and calculated from the images in which the deepest penetration was observed. The penetration ratio was significantly decreased in the chin tuck posture compared with the ratio in the neutral position (p = 0.001). Significant reducing effect was observed in 26 (34.2%) out of 76 patients. When comparing other parameters of VFSS, residues in the vallecular and pyriformis sinuses were less severe in the effective group. Chin tuck significantly decreased residues in both effective and ineffective group. The results demonstrate that the chin tuck maneuver can reduce penetration, but its effectiveness is limited.

YouTube as a Source of Patient Information Regarding Exercises and Compensated Maneuvers for Dysphagia

“…To treat or improve symptoms of dysphagia, various methods have been reported. Conventional treatment methods such as oropharyngeal exercises and compensated maneuvers, such as the chin-tuck maneuver, are widely used to improve the symptoms of dysphagia [5][6][7][8][9].…”

Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice – Balancing pharmacological and non-pharmacological approaches

“…The chin-tuck maneuver, also known as the chin-down posture ( Figure 4 ), is a commonly used compensatory strategy; however, its reported effectiveness in studies in patients with PD with dysphagia has varied ( Ra et al, 2014 ; Saconato et al, 2016 ). These early studies often lacked clear objective markers, however, more recent evidence from studies using objective outcomes has demonstrated that it has a significant benefit in reducing laryngeal penetration in patients with PD with dysphagia ( Ko et al, 2021 ). However, in real-world clinical practice, while the chin-tuck maneuver has proven benefits and is relatively easy to explain, for patients with PD who may have existing postural problems or tremors, it may be challenging initially ( Schindler et al, 2021 ).…”

Effects of the Chin-Tuck Maneuver on Anatomical Changes and Angles during Swallowing: A Systematic Review

“…The results showed that in the chin-down position, penetration and aspiration were minimized by expanding the epiglottic vallecula and narrowing the laryngeal inlet. In addition, using VFSS, Ko et al 24 investigated the effects of the chin-tuck position on penetration and aspiration in patients with swallowing disorders, as well as factors affecting chin tuck effectiveness; they found that the chin-tuck position reduces the depth and rate of aspiration and also reduces the amount of pharyngeal residues.…”

“…However, as the terms defining the chin-tuck position and the reference points for measuring the angles used in the three papers were different, it is difficult to confirm whether these results actually indicate consistency. In addition, Ko et al24 revealed that the chin-tuck maneuver was effective but noted the limitation that neck flexion angles could not be accurately measured, resulting in biased results. This is demonstrated in continuing study by Chin-tuck, in which the neck angles are not accurately measured, and other studies have confirmed that definitions of the chin-tuck position vary JKDS Vol.…”