Assessing Hyolaryngeal Excursion: Comparing Quantitative Methods to Palpation at the Bedside and Visualization During...

Area of Science:

• Swallowing disorders
• Deglutition biomechanics
• Clinical assessment methods

Background:

• Hyolaryngeal excursion (HE) is crucial for safe swallowing.
• Current clinical assessment methods include palpation during clinical swallowing exams (CSE) and visual inspection during videofluoroscopy (VFSS).
• Evidence supporting the reliability of these perceptual methods for judging HE is limited.

Purpose of the Study:

• To investigate if subjective clinical judgments of HE differentiate objective, quantitative measures of hyoid bone movement.
• To compare perceptual assessments of HE with frame-by-frame videofluoroscopy (VFSS) analysis.

Main Methods:

• Retrospective review of medical records for patients who underwent both CSE and VFSS within 24 hours.
• Analysis of 5 ml puree swallows from VFSS, measuring peak hyoid position (anterior, superior, hypotenuse) relative to C2-C4 length.
• Comparison of objective hyoid positions between patients with 'reduced' versus 'normal' HE ratings from CSE and VFSS.

Main Results:

• Peak anterior hyoid position significantly differed between 'reduced' (89.2% C2-C4) and 'normal' (110.6% C2-C4) HE judgments on palpation (p=0.001).
• Clinician experience did not affect the ability to differentiate objective measures based on palpation.
• No significant differences in objective hyoid movement measures were found when compared to VFSS ratings.

Conclusions:

• Clinicians can differentiate peak anterior hyoid movement via palpation but not superior or hypotenuse movement.
• VFSS visualization did not reveal significant directional differences in HE based on perceptual ratings.
• While perceptual methods inform clinical decisions, caution is advised when judging HE using these subjective assessments.