The paper describes a mechanistic mathematical model for aroma release in the oropharynx to the nasal cavity during food consumption. The model is based on the physiology of the swallowing process and is validated with atmospheric pressure chemical ionization coupled with mass spectrometry measurements of aroma concentration in the nasal cavity of subjects eating flavored yogurt. The study is conducted on 3 aroma compounds representative for strawberry flavor (ethyl acetate, ethyl butanoate, and ethyl hexanoate) and 3 panelists. The model provides reasonably accurate time predictions of the relative aroma concentration in the nasal cavity and is able to simulate successive swallowing events as well as imperfect velopharyngeal closure. The most influent parameters are found to be the amount of the residual product in the pharynx and its contact area with the air flux, the volume of the nasal cavity, the equilibrium air/product partition coefficient of the volatile compound, the breath airflow rate, as well as the mass transfer coefficient of the aroma compound in the product, and the amount of product in the mouth. This work constitutes a first step toward computer-aided product formulation by allowing calculation of retronasal aroma intensity as a function of transfer and volatility properties of aroma compounds in food matrices and anatomophysiological characteristics of consumers.

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Mechanistic mathematical model for in vivo aroma release during eating of semiliquid foods.

Objective To investigate swallowing laterality in hemiplegic patients with stroke and recovery of dysphagia according to the laterality. Method The sample was comprised of 46 dysphagic patients with hemiplegia after their first stroke. The sample’s videofluoroscopic swallowing study (VFSS) was reviewed. Swallowing laterality was determined by the anteriorposterior view of VFSS. We measured width difference of barium sulfate liquid flow in the pharyngoesophageal segment. If there was double or more the width of that from the opposite width in the pharyngoesophageal segment more than twice on three trials of swallowing, then it was judged as having laterality. Subjects were assigned to no laterality (NL), laterality that is ipsilateral to hemiplegic side (LI), and laterality that is contralateral to hemiplegic side (LC) groups. We measured the following: prevalence of aspiration, the 8-point penetrationaspiration scale, and the functional dysphagia scale of the subjects at baseline and follow up. Results Laterality was observed in 45.7% of all patients. Among them, 52.4% were in the hemiplegic direction. There was no significant difference between groups at baseline in all measurements. When we compared the changes in all measurements on follow-up study, there were no significant differences between groups. Conclusion Through this study, we found that there was no significant relation between swallowing laterality and the severity or prognosis of swallowing difficulty. More studies for swallowing laterality on stroke patients will be needed.

The Influence of Laterality of Pharyngeal Bolus Passage on Dysphagia in Hemiplegic Stroke Patients

A swallowing disorder is present in more than 50% of patients with acute stroke. Objective To identify clinical prognostic indicators of the swallowing function in a population with acute ischemic stroke and to determine prioritization indicators for swallowing rehabilitation. Methods Participants were adults admitted to the emergency room who were diagnosed with acute ischemic stroke. Data gathering involved a swallowing assessment to determine the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System – ASHA NOMS) and the verification of demographic and clinical variables. Results The study sample included 295 patients. For analysis purposes, patients were grouped as follows: ASHA NOMS levels 1 and 2 – ASHA1 (n = 51); levels 3, 4 and 5 – ASHA2 (n = 96); levels 6 and 7 – ASHA3 (n = 148). Statistical analyses indicated that patients who presented a poorer swallowing function (ASHA1) were older (age ≥ 70 years); had anterior circulation infarct; had lower scores on the Glasgow Coma Scale (GCS ≤ 14 points); took longer to initiate swallowing rehabilitation; had longer hospital stays; made more use of alternative feeding methods; needed more sessions of swallowing rehabilitation to remove alternate feeding methods; took longer to return to oral feeding and had poorer outcomes (fewer individuals discharged from swallowing rehabilitation sessions and increased mortality). Conclusion Patients with acute ischemic stroke, admitted to the emergency room, aged ≥ 70 years, score on the GCS ≤ 14, anterior circulation infarct and dementia should be prioritized for swallowing assessment and rehabilitation.

/pdf/clinical-swallowing-prognostic-indicators-in-patients-with-sfvulpjg1t.pdf

Clinical swallowing prognostic indicators in patients with acute ischemic stroke.

INTRODUCAO: Durante o processo de envelhecimento, uma das funcoes que sofre modificacao e a degluticao. Estas alteracoes na degluticao orofaringea podem ser diagnosticadas por metodos que permitem tanto o diagnostico quanto o monitoramento e biofeedback ao individuo. Um dos metodos descrito na literatura recentemente para a avaliacao da degluticao e o Sonar Doppler. OBJETIVO: O objetivo desse estudo foi comparar os parâmetros acusticos da degluticao orofaringea entre faixas etarias distintas. METODO: Estudo de campo, quantitativo. O exame com o Sonar Doppler foi aplicado em 75 idosos e 72 adultos. Estabeleceram-se os parâmetros acusticos: frequencia inicial, frequencia do primeiro pico, frequencia do segundo pico, intensidade inicial, intensidade final e tempo, para as degluticoes de saliva, liquido, nectar, mel e pudim, com gole livre, 5 mL e 10 mL. RESULTADOS: Obtiveram-se dados objetivos e mensuraveis, apresentando significância para a maioria dos parâmetros acusticos estudados entre o grupo de idosos e adultos em relacao a consistencia e volume. CONCLUSAO: Verificamos que ha modificacao do padrao acustico da degluticao, tanto em relacao a consistencia quanto a volume do bolo alimentar, quando comparados adultos idosos e nao idosos.

Acoustic analysis of oropharyngeal swallowing using Sonar Doppler

Pharyngeal residue, the material that remains in the pharynx after swallowing, is an important marker of impairments in swallowing and prandial aspiration risk. The goals of this study were to determine whether the 2D area of post-swallow residue accurately represents its 3D volume, and if the laterality of residue would affect this association. Thirteen patients with dysphagia due to brainstem stroke completed dynamic 320-detector row computed tomography while swallowing a trial of 10 ml honey-thick barium. 3D volumes of pharyngeal residue were compared to 2D lateral and anterior–posterior areas, and a laterality index for residue location was computed. Although the anteroposterior area of residue was larger than the lateral area, the two measures were positively correlated with one another and with residue volume. On separate bivariate regression analyses, residue volume was accurately predicted by both lateral (R2 = 0.91) and anteroposterior (R2 = 0.88) residue areas, with limited incidence of high residuals. Half of the sample demonstrated a majority of pharyngeal residue lateralized to one side of the pharynx, with no effect of laterality on the association between areas and volume. In conclusion, the area of post-swallow pharyngeal residue was associated with volume, with limitations in specific cases. Direct measurement of pharyngeal residue volume and swallowing physiology with 3D-CT can be used to validate results from standard 2D instrumentation.

The Association of 3-D Volume and 2-D Area of Post-swallow Pharyngeal Residue on CT Imaging.

Although anteroposterior projections in videofluoroscopic examination of swallowing (VF) provide clinically important information, the laterality of swallowing in healthy subjects has not been examined fully to date. One hundred sixty-seven healthy volunteers were prospectively studied. The subjects were asked to swallow 5 ml of barium solution three times while X-ray images were taken that showed the pathway of the solution from the pharynx into the esophagus to assess the laterality of swallowing. We classified patterns of swallowing into three types according to passage in the pharyngoesophageal segment as indicated by width: RD (right-side-dominant flow), LD (left-side-dominant flow), and NL (no laterality in flow). Fifty-eight percent of the subjects were classified as NL, 35% as LD, and 7% as RD. The ratio of types in women was NL:LD:RD = 7:2:1. There were no significant differences among the groups according to age. Although classifications in young men (age = 20–30 years) tended to be the same as in women regardless of age, ratios of LD tended to increase with age; 71% of elderly adults (age = 51–75 years) were classified as LD. These results demonstrate laterality in normal swallowing and will be helpful in determining treatment strategies for the patients with dysphagia.

https://link.springer.com/content/pdf/10.1007%2Fs00455-006-9021-z.pdf

Haruo Inada

Papers

Laterality of swallowing in healthy subjects by AP projection using videofluoroscopy.