Respiratory‐swallow coordination and swallowing impairment in head and neck cancer

Abstract

Background The aim of the study was to determine the link between frequency of optimal respiratory‐swallow coordination, swallowing impairment, and airway invasion in head and neck cancer (HNC) patients. Method A cross‐sectional study of a heterogeneous group of HNC patients (49), precancer (N = 30) or postcancer treatment (N = 29), participated in a single Modified Barium Swallow Study (MBSS) with synchronized respiratory data. Results Spearman correlation coefficients revealed significant negative correlations between optimal respiratory‐swallow phase pattern and objective measures of swallowing impairment: penetration‐aspiration scale max, pharyngeal total, and oral total scores with Spearman correlation coefficients of −0.53 (z .001), −0.50 (P < .001), and −0.43 (P = .002), respectively. Optimal respiratory‐swallow pattern was significantly decreased (P = .03) in patients after cancer treatment compared with another patient group before cancer treatment. Conclusion These findings indicate that as the percentage of optimal respiratory‐swallow phase patterns increase, swallowing impairment decreases in the HNC patient population.

A prospective examination of swallow and cough dysfunction after lung transplantation

“…58 Evidence also suggests that pharyngeal swallowing occurs at optimal lung volumes (42%-65% of vital capacity) 27,59 and, when out of these confines, are more likely to result in atypical respiratory patterning and increased risk for aspiration. Although work investigating respiratory-swallow coordination in LT recipients has not been explored, alterations in respiratory-swallow coordination have been recognized to increase the risk for airway invasion in patients with chronic obstructive pulmonary disease, [60][61] head and neck cancer, [62][63] and Parkinson's disease. [60][61][62][63][64][65] This study has certain limitations, providing guidance for future investigations.…”

“…Although work investigating respiratory-swallow coordination in LT recipients has not been explored, alterations in respiratory-swallow coordination have been recognized to increase the risk for airway invasion in patients with chronic obstructive pulmonary disease, [60][61] head and neck cancer, [62][63] and Parkinson's disease. [60][61][62][63][64][65] This study has certain limitations, providing guidance for future investigations. First, the non-standardized timeframe of data acquisition following LT could not be avoided and does limit interpretations of these results beyond the acute care period.…”

Soft skin-interfaced mechano-acoustic sensors for real-time monitoring and patient feedback on respiratory and swallowing biomechanics

“…In healthy adults, the timing of swallow initiation typically corresponds with a pause in the expiratory phase of quiet breathing at mid-to-low lung volumes 7,8,[10][11][12] . This coordinative pattern (1) serves as a vital mechanism for airway protection, (2) facilitates physiological events beneficial to swallowing safety and efficiency, such as tongue base retraction, laryngeal elevation, and pharyngoesophageal segment opening, and (3) subsequently aids in bolus clearance [13][14][15] . However, it is well-documented that the coordination of breathing with swallowing is significantly disrupted in patients with dysphagia, resulting in impairments in the swallowing mechanism and significant decreases in health and quality of life.…”

Dysphagia Management and Cervical Auscultation: Reliability and Validity Against FEES

“…A crucial component to swallowing, and therefore to CA, is the swallow-respiratory coordination. The physiology and swallow-respiratory interplay within both normal and dysphagic swallows is well described in the literature [22,27,28,[32][33][34][35][36]. Respiratory swallow patterns are represented by expiration-swallowexpiration as the most common pattern followed by inspiration-swallow-expiration as the second most frequent pattern [32,33,37].…”

“…Studies show that patients with dysphagia have disrupted swallow-respiratory coordination usually represented by an inspiration post swallow, which increases the risk of penetration or aspiration, and a shorter duration of post swallow expiratory sounds than compared with healthy swallow-respiratory sounds [29,30]. Swallow-respiratory patterns which deviate from normal are prevalent in several different (adult) patient groups including stroke, chronic obstructive pulmonary disease/respiratory diseases, Parkinson's disease, head and neck cancer [34][35][36]38]. Within pediatrics (neonatal and older children), the (suck-) swallowbreathe synchrony is again essential for safe and efficient feeding and swallowing [8,17,18,22,31].…”