Outcomes of laryngohyoid suspension techniques in an ovine model of profound oropharyngeal dysphagia

Christopher M. Johnson, Naren N. Venkatesan, M. Tausif Siddiqui, Daniel Cates, Maggie Kuhn, Gregory M. Postma, Peter C Belafsky

Research output: Contribution to journalArticle

Abstract

Objectives/Hypothesis: To evaluate the efficacy of various techniques of laryngohyoid suspension in the elimination of aspiration utilizing a cadaveric ovine model of profound oropharyngeal dysphagia. Study Design: Animal study. Methods: The head and neck of a Dorper cross ewe was placed in the lateral fluoroscopic view. Five conditions were tested: baseline, thyroid cartilage to hyoid approximation (THA), thyroid cartilage to hyoid to mandible (laryngohyoid) suspension (LHS), LHS with cricopharyngeus muscle myotomy (LHS-CPM), and cricopharyngeus muscle myotomy (CPM) alone. Five 20-mL trials of barium sulfate were delivered into the oropharynx under fluoroscopy for each condition. Outcome measures included the penetration aspiration scale (PAS) and the National Institutes of Health (NIH) Swallow Safety Scale (NIH-SSS). Results: Median baseline PAS and NIH-SSS scores were 8 and 6, respectively, indicating severe impairment. THA scores were not improved from baseline. LHS alone reduced the PAS to 1 (P = .025) and NIH-SSS to 2 (P = .025) from baseline. LHS-CPM reduced the PAS to 1 (P = .025) and NIH-SSS to 0 (P = .025) from baseline. CPM alone did not improve scores. LHS-CPM displayed improved NIH-SSS over LHS alone (P = .003). Conclusions: This cadaveric model represents end-stage profound oropharyngeal dysphagia such as what could result from severe neurological insult. CPM alone failed to improve fluoroscopic outcomes in this model. Thyrohyoid approximation also failed to improve outcomes. LHS significantly improved both PAS and NIH-SSS. The addition of CPM to LHS resulted in improvement over suspension alone.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StateAccepted/In press - 2017

Fingerprint

Deglutition Disorders
Pharyngeal Muscles
Sheep
Suspensions
National Institutes of Health (U.S.)
Thyroid Cartilage
Barium Sulfate
Swallows
Oropharynx
Fluoroscopy
Mandible
Neck
Head
Outcome Assessment (Health Care)
Safety

Keywords

  • Aspiration
  • Cricopharyngeus muscle myotomy
  • Dysphagia
  • Laryngeal suspension
  • Laryngohyoid approximation
  • Laryngohyoid suspension
  • National Institutes of Health swallowing safety scale
  • Oropharyngeal dysphagia
  • Ovine model
  • Penetration aspiration scale
  • Pharyngoesophageal segment
  • Upper esophageal sphincter

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Outcomes of laryngohyoid suspension techniques in an ovine model of profound oropharyngeal dysphagia. / Johnson, Christopher M.; Venkatesan, Naren N.; Siddiqui, M. Tausif; Cates, Daniel; Kuhn, Maggie; Postma, Gregory M.; Belafsky, Peter C.

In: Laryngoscope, 2017.

Research output: Contribution to journalArticle

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abstract = "Objectives/Hypothesis: To evaluate the efficacy of various techniques of laryngohyoid suspension in the elimination of aspiration utilizing a cadaveric ovine model of profound oropharyngeal dysphagia. Study Design: Animal study. Methods: The head and neck of a Dorper cross ewe was placed in the lateral fluoroscopic view. Five conditions were tested: baseline, thyroid cartilage to hyoid approximation (THA), thyroid cartilage to hyoid to mandible (laryngohyoid) suspension (LHS), LHS with cricopharyngeus muscle myotomy (LHS-CPM), and cricopharyngeus muscle myotomy (CPM) alone. Five 20-mL trials of barium sulfate were delivered into the oropharynx under fluoroscopy for each condition. Outcome measures included the penetration aspiration scale (PAS) and the National Institutes of Health (NIH) Swallow Safety Scale (NIH-SSS). Results: Median baseline PAS and NIH-SSS scores were 8 and 6, respectively, indicating severe impairment. THA scores were not improved from baseline. LHS alone reduced the PAS to 1 (P = .025) and NIH-SSS to 2 (P = .025) from baseline. LHS-CPM reduced the PAS to 1 (P = .025) and NIH-SSS to 0 (P = .025) from baseline. CPM alone did not improve scores. LHS-CPM displayed improved NIH-SSS over LHS alone (P = .003). Conclusions: This cadaveric model represents end-stage profound oropharyngeal dysphagia such as what could result from severe neurological insult. CPM alone failed to improve fluoroscopic outcomes in this model. Thyrohyoid approximation also failed to improve outcomes. LHS significantly improved both PAS and NIH-SSS. The addition of CPM to LHS resulted in improvement over suspension alone.",
keywords = "Aspiration, Cricopharyngeus muscle myotomy, Dysphagia, Laryngeal suspension, Laryngohyoid approximation, Laryngohyoid suspension, National Institutes of Health swallowing safety scale, Oropharyngeal dysphagia, Ovine model, Penetration aspiration scale, Pharyngoesophageal segment, Upper esophageal sphincter",
author = "Johnson, {Christopher M.} and Venkatesan, {Naren N.} and Siddiqui, {M. Tausif} and Daniel Cates and Maggie Kuhn and Postma, {Gregory M.} and Belafsky, {Peter C}",
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T1 - Outcomes of laryngohyoid suspension techniques in an ovine model of profound oropharyngeal dysphagia

AU - Johnson, Christopher M.

AU - Venkatesan, Naren N.

AU - Siddiqui, M. Tausif

AU - Cates, Daniel

AU - Kuhn, Maggie

AU - Postma, Gregory M.

AU - Belafsky, Peter C

PY - 2017

Y1 - 2017

N2 - Objectives/Hypothesis: To evaluate the efficacy of various techniques of laryngohyoid suspension in the elimination of aspiration utilizing a cadaveric ovine model of profound oropharyngeal dysphagia. Study Design: Animal study. Methods: The head and neck of a Dorper cross ewe was placed in the lateral fluoroscopic view. Five conditions were tested: baseline, thyroid cartilage to hyoid approximation (THA), thyroid cartilage to hyoid to mandible (laryngohyoid) suspension (LHS), LHS with cricopharyngeus muscle myotomy (LHS-CPM), and cricopharyngeus muscle myotomy (CPM) alone. Five 20-mL trials of barium sulfate were delivered into the oropharynx under fluoroscopy for each condition. Outcome measures included the penetration aspiration scale (PAS) and the National Institutes of Health (NIH) Swallow Safety Scale (NIH-SSS). Results: Median baseline PAS and NIH-SSS scores were 8 and 6, respectively, indicating severe impairment. THA scores were not improved from baseline. LHS alone reduced the PAS to 1 (P = .025) and NIH-SSS to 2 (P = .025) from baseline. LHS-CPM reduced the PAS to 1 (P = .025) and NIH-SSS to 0 (P = .025) from baseline. CPM alone did not improve scores. LHS-CPM displayed improved NIH-SSS over LHS alone (P = .003). Conclusions: This cadaveric model represents end-stage profound oropharyngeal dysphagia such as what could result from severe neurological insult. CPM alone failed to improve fluoroscopic outcomes in this model. Thyrohyoid approximation also failed to improve outcomes. LHS significantly improved both PAS and NIH-SSS. The addition of CPM to LHS resulted in improvement over suspension alone.

AB - Objectives/Hypothesis: To evaluate the efficacy of various techniques of laryngohyoid suspension in the elimination of aspiration utilizing a cadaveric ovine model of profound oropharyngeal dysphagia. Study Design: Animal study. Methods: The head and neck of a Dorper cross ewe was placed in the lateral fluoroscopic view. Five conditions were tested: baseline, thyroid cartilage to hyoid approximation (THA), thyroid cartilage to hyoid to mandible (laryngohyoid) suspension (LHS), LHS with cricopharyngeus muscle myotomy (LHS-CPM), and cricopharyngeus muscle myotomy (CPM) alone. Five 20-mL trials of barium sulfate were delivered into the oropharynx under fluoroscopy for each condition. Outcome measures included the penetration aspiration scale (PAS) and the National Institutes of Health (NIH) Swallow Safety Scale (NIH-SSS). Results: Median baseline PAS and NIH-SSS scores were 8 and 6, respectively, indicating severe impairment. THA scores were not improved from baseline. LHS alone reduced the PAS to 1 (P = .025) and NIH-SSS to 2 (P = .025) from baseline. LHS-CPM reduced the PAS to 1 (P = .025) and NIH-SSS to 0 (P = .025) from baseline. CPM alone did not improve scores. LHS-CPM displayed improved NIH-SSS over LHS alone (P = .003). Conclusions: This cadaveric model represents end-stage profound oropharyngeal dysphagia such as what could result from severe neurological insult. CPM alone failed to improve fluoroscopic outcomes in this model. Thyrohyoid approximation also failed to improve outcomes. LHS significantly improved both PAS and NIH-SSS. The addition of CPM to LHS resulted in improvement over suspension alone.

KW - Aspiration

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KW - Laryngohyoid approximation

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KW - National Institutes of Health swallowing safety scale

KW - Oropharyngeal dysphagia

KW - Ovine model

KW - Penetration aspiration scale

KW - Pharyngoesophageal segment

KW - Upper esophageal sphincter

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