Hyolaryngeal Movement During Normal and Effortful Swallows Determined During Ultrasonography

Purpose: This study investigated (a) the effects of the effortful swallow untwo different instructions (tongue emphasis vs. pharyngeal squeezing) on hyodisplacement and hyoid–larynx approximation, (b) the association between tongue pressure and hyolaryngeal movement during normal swallowing and theffortful swallow produced with tongue emphasis, and (c) age-related diffeences in hyolaryngeal movement during normal and effortful swallows (tonguemphasis vs. pharyngeal squeezing) in healthy individuals. Method: Forty healthy adults (20 younger and 20 older) swallowed their salas they normally do (normal swallow) and performed the effortful swallow wtongue emphasis and pharyngeal squeezing. Tongue-to-palate pressure during swallowing was measured using the Iowa Oral Performance Instrument, hyolayngeal movement was measured using ultrasonography, and submental surfacelectromyography was used to track swallows. Results: Results revealed differences in hyolaryngeal movement across swallowing types. Both types of effortful swallows showed greater hyolaryngemovement than normal swallows. Additionally, hyolaryngeal movement was greater during the effortful swallow with tongue emphasis than the effortswallow with pharyngeal squeezing. Age-related differences were found only hyoid–larynx approximation during the effortful swallow with tongue emphasi(younger > older adults). Furthermore, moderate positive correlations were iden-tified between tongue pressure and hyolaryngeal movement during normal swalows and the effortful swallow with tongue emphasis. Conclusions: The findings show that varying instructions of the effortful swalloaffect hyolaryngeal movement differently, suggesting that clinicians may need tindividualize the effortful swallow instruction according to the physiologicaimpairments of each patient. Additionally, natural age-related changes in swalowing physiology do not seem to affect an individual’s ability to perform effortful swallow or to impact hyolaryngeal movement. Finally, the associatiobetween tongue pressure and hyolaryngeal movement during normal swallowand the effortful swallow with tongue emphasis suggests that the tongue plaa critical role in swallowing, priming subsequent swallowing events.