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Updated: Jan 3, 2026
Adapting Human Videofluoroscopic Swallow Study Methods to Detect and Characterize Dysphagia in Murine Disease Models
Published on: March 1, 2015
Dysphagia in Myositis: A Study of the Structural and Physiologic Changes Resulting in Disordered Swallowing
Alba Azola1, Rachel Mulheren, Genevieve Mckeon
1From the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland (AA, RM, JP, THC); Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio (RM); Rehabilitation Department, Johns Hopkins Bayview Medical Center, Baltimore, Maryland (GM); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland (TL, THC); and Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland (LC-S).
Objectives:
Dysphagia in patients with myositis is associated with an increased risk of aspiration pneumonia. However, the pathophysiology of dysphagia is poorly understood. The aim of this study was to understand how myositis affects swallowing physiology on videofluoroscopic swallow study.
Design:
This is a retrospective review of video fluoroscopic swallowing studies on 23 myositis patients with dysphagia from 2011 to 2016. Swallow studies were analyzed by timing of swallowing events and duration of swallowing events, diameter of upper esophageal sphincter opening, Modified Barium Swallow Impairment Profile, and Penetration-Aspiration Scale. The outcome measures for patients were compared with an archived videofluoroscopic swallow study from healthy, age-matched participants by Wilcoxon rank-sum tests.
Results:
Patients with myositis had a shorter duration of upper esophageal sphincter opening (P < 0.0001) and laryngeal vestibule closure (P < 0.0001) than healthy subjects. The diameter of upper esophageal sphincter opening did not differ between groups. Patients with myositis presented with higher scores on the MBSIMP than healthy subjects, indicating great impairment particularly during the pharyngeal phase of swallowing, and a higher frequency of penetration and aspiration.
Conclusions:
Dysphagia in patients with myositis may be attributed to reduced endurance of swallowing musculature rather than mechanical obstruction of the upper esophageal sphincter.
Insights
Patients with myositis experience dysphagia due to reduced swallowing muscle endurance, not upper esophageal sphincter obstruction. This impacts swallowing physiology and increases aspiration risk.
Area of Science:
- Neurology
- Gastroenterology
- Otolaryngology
Background:
- Dysphagia in myositis patients elevates aspiration pneumonia risk.
- The underlying pathophysiology of myositis-related dysphagia remains unclear.
Purpose of the Study:
- To investigate the effects of myositis on swallowing physiology using videofluoroscopic swallow studies (VFSS).
- To elucidate the mechanisms behind dysphagia in myositis.
Main Methods:
- Retrospective review of VFSS from 23 myositis patients with dysphagia (2011-2016).
- Analysis of swallowing event timing and duration, upper esophageal sphincter (UES) opening diameter, Modified Barium Swallow Impairment Profile (MBSImP), and Penetration-Aspiration Scale (PAS).
- Comparison with healthy controls using Wilcoxon rank-sum tests.
Main Results:
- Myositis patients exhibited shorter UES opening duration and laryngeal vestibule closure duration compared to controls (P < 0.0001).
- No significant difference in UES opening diameter was observed.
- Myositis patients showed higher MBSImP scores, indicating pharyngeal phase impairment, and increased penetration-aspiration events.
Conclusions:
- Dysphagia in myositis appears linked to reduced swallowing muscle endurance.
- Findings suggest impaired pharyngeal motility rather than mechanical UES obstruction as the primary cause.
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