Relationship between muscular atrophy of the tongue and impairment of bolus transport during swallowing in patients with amyotrophic lateral sclerosis

The present study was focused on the tongue atrophy which is one of the common symptom in patients with amyotrophic lateral sclerosis (ALS) and investigated the effects of tongue atrophy on impairment of swallowing function by using videofluorographic assessment. The subjects included 19 patients di...

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Published inThe Journal of Japanese Society of Stomatognathic Function Vol. 15; no. 1; pp. 30 - 37
Main Authors Yamada, Yoshiaki, Taniguchi, Hiroshige, Inoue, Makoto, Ootaki, Sachiko, Kajii, Yuka
Format Journal Article
LanguageJapanese
Published Japanese Society of Stomatognathic Function 30.10.2008
Subjects
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ISSN1340-9085
1883-986X
DOI10.7144/sgf.15.30

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Abstract The present study was focused on the tongue atrophy which is one of the common symptom in patients with amyotrophic lateral sclerosis (ALS) and investigated the effects of tongue atrophy on impairment of swallowing function by using videofluorographic assessment. The subjects included 19 patients diagnosed ALS and 11 age-matched normal adults. Each subject was asked to swallow 3 ml water with 40 vt/wt% barium sulfate. Whether aspiration and/or penetration of bolus before, during and after swallowing was observed or not and amount of bolus residues in the pharynx were evaluated. Furthermore, in case of no aspiration observed, bolus transit times were measured and compared among the groups. All the cases in which the patient had an episode of aspiration were related to the muscular atrophy of tongue. The patient group showing tongue atrophy exhibited higher scores of pharyngeal residue than the other groups, meaning that the amount of pharyngeal residues after the swallow in the former group was much more than that of patients with no atrophy of the tongue or normal adults. Comparing the bolus transit time among the atrophic tongue in patients without aspiration, normal tongue in patients and normal adults, Clearance Time, i.e., the time of the bolus invading the pharynx and Upper Esophageal Segment Transit Time were delayed and the bolus head reached at the bottom of hypopharynx before onset of swallowing in the first group. It may be possible that abnormal structure and motility and/or extension of pharyngeal duct due to the atrophy of tongue may cause the difficulty in the bolus handling in the oral cavity and delay of triggering reflex swallowing. All the results obtained in the present study suggested that the muscular atrophy of tongue in patients with ALS may be a critical sign for the risk of severe problem with swallowing function.
AbstractList The present study was focused on the tongue atrophy which is one of the common symptom in patients with amyotrophic lateral sclerosis (ALS) and investigated the effects of tongue atrophy on impairment of swallowing function by using videofluorographic assessment. The subjects included 19 patients diagnosed ALS and 11 age-matched normal adults. Each subject was asked to swallow 3 ml water with 40 vt/wt% barium sulfate. Whether aspiration and/or penetration of bolus before, during and after swallowing was observed or not and amount of bolus residues in the pharynx were evaluated. Furthermore, in case of no aspiration observed, bolus transit times were measured and compared among the groups. All the cases in which the patient had an episode of aspiration were related to the muscular atrophy of tongue. The patient group showing tongue atrophy exhibited higher scores of pharyngeal residue than the other groups, meaning that the amount of pharyngeal residues after the swallow in the former group was much more than that of patients with no atrophy of the tongue or normal adults. Comparing the bolus transit time among the atrophic tongue in patients without aspiration, normal tongue in patients and normal adults, Clearance Time, i.e., the time of the bolus invading the pharynx and Upper Esophageal Segment Transit Time were delayed and the bolus head reached at the bottom of hypopharynx before onset of swallowing in the first group. It may be possible that abnormal structure and motility and/or extension of pharyngeal duct due to the atrophy of tongue may cause the difficulty in the bolus handling in the oral cavity and delay of triggering reflex swallowing. All the results obtained in the present study suggested that the muscular atrophy of tongue in patients with ALS may be a critical sign for the risk of severe problem with swallowing function.
Author Taniguchi, Hiroshige
Inoue, Makoto
Kajii, Yuka
Yamada, Yoshiaki
Ootaki, Sachiko
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  organization: Niigata University
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  fullname: Taniguchi, Hiroshige
  organization: Division of Dysphagia Rehabilitation, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences
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  fullname: Inoue, Makoto
  organization: Division of Dysphagia Rehabilitation, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences
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  fullname: Ootaki, Sachiko
  organization: Unit of Dysphagia Rehabilitation, Niigata University Medical and Dental Hospital
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  fullname: Kajii, Yuka
  organization: Unit of Dysphagia Rehabilitation, Niigata University Medical and Dental Hospital
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References 8) Edythe, A. S., Robert, M. M., Kathryn, M. Y, et al.: Management of Oral-Pharyngeal Dysphagia Symptoms in Amyotrophic Lateral Sclerosis. Dysphagia 11: 129-139, 1996
3) 市原典子, 橋本龍幸, 下岡あずさ: ALSにおける嚥下障害の特徴と食事援助法. 神経内科, 58 (3) : 285-294, 2003
7) Logemann, J. A.: Manual for the videofluoroscopic study of swallowing. Austin, TX: PRO-ED.
9) Dantas, R. O., Kern, M. K., Massey, B. T. et al.: Effect of Swallowed Bolus Variables on Oral and Pharyngeal Phases of Swallowing. Am J Physiol 258 (5 Pt 1) : G675-681, 1990
6) Cook, I. J., Dodds, W. J., Dantas, R. O. et al.: Timing of Videofluoroscopic, Manometric Events, and Bolus Transit During the Oral and Pharyngeal Phases of Swallowing. Dysphagia 4 (1) : 8-15, 1989
1) 厚生労働省難治性疾患克服研究班: ALS治療ガイドライン: 2007
2) Groher, M. E.: Dysphagic patients with progressive neurologic disease. Semin Neurol. Dec 16 (4) : 355-63, 1996
4) Hillel, A. D., Miller, R. M., Yorkston, K. M. et al.: ALS Severity Scale. J Neuroepidemiol 8: 142-150, 1989
10) Johnsson, F., Shaw, D., Gabb, M, et al.: Influence of gravity and position on normal oropharyngeal swallowing. Am J Physiol 269 (5 Pt 1) : G653-658, 1995
5) Dodds, W. J., Taylor, A. J., Stewart, E. T. et al.: Tipper and dipper types of oral swallows. AJR Am J Roentgenol. Dec; 153 (6) : 1197-9, 1989
References_xml – reference: 10) Johnsson, F., Shaw, D., Gabb, M, et al.: Influence of gravity and position on normal oropharyngeal swallowing. Am J Physiol 269 (5 Pt 1) : G653-658, 1995
– reference: 3) 市原典子, 橋本龍幸, 下岡あずさ: ALSにおける嚥下障害の特徴と食事援助法. 神経内科, 58 (3) : 285-294, 2003
– reference: 9) Dantas, R. O., Kern, M. K., Massey, B. T. et al.: Effect of Swallowed Bolus Variables on Oral and Pharyngeal Phases of Swallowing. Am J Physiol 258 (5 Pt 1) : G675-681, 1990
– reference: 1) 厚生労働省難治性疾患克服研究班: ALS治療ガイドライン: 2007
– reference: 8) Edythe, A. S., Robert, M. M., Kathryn, M. Y, et al.: Management of Oral-Pharyngeal Dysphagia Symptoms in Amyotrophic Lateral Sclerosis. Dysphagia 11: 129-139, 1996
– reference: 2) Groher, M. E.: Dysphagic patients with progressive neurologic disease. Semin Neurol. Dec 16 (4) : 355-63, 1996
– reference: 6) Cook, I. J., Dodds, W. J., Dantas, R. O. et al.: Timing of Videofluoroscopic, Manometric Events, and Bolus Transit During the Oral and Pharyngeal Phases of Swallowing. Dysphagia 4 (1) : 8-15, 1989
– reference: 7) Logemann, J. A.: Manual for the videofluoroscopic study of swallowing. Austin, TX: PRO-ED.
– reference: 4) Hillel, A. D., Miller, R. M., Yorkston, K. M. et al.: ALS Severity Scale. J Neuroepidemiol 8: 142-150, 1989
– reference: 5) Dodds, W. J., Taylor, A. J., Stewart, E. T. et al.: Tipper and dipper types of oral swallows. AJR Am J Roentgenol. Dec; 153 (6) : 1197-9, 1989
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Snippet The present study was focused on the tongue atrophy which is one of the common symptom in patients with amyotrophic lateral sclerosis (ALS) and investigated...
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SubjectTerms ALS
bolus transport
tongue atrophy
videofluorography
Title Relationship between muscular atrophy of the tongue and impairment of bolus transport during swallowing in patients with amyotrophic lateral sclerosis
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