Affiliation:
1. Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication Northwestern University Evanston Illinois USA
2. Edward J. Hines, Jr. Veterans Affairs Medical Center Hines Illinois USA
3. Department of Preventive Medicine (Biostatistics), Feinberg School of Medicine Northwestern University Chicago Illinois USA
4. Department of Medical Social Sciences and Institute for Innovations in Developmental Sciences, Feinberg School of Medicine Northwestern University Chicago Illinois USA
5. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine Northwestern University Chicago Illinois USA
6. Department of Otolaryngology‐Head and Neck Surgery, Feinberg School of Medicine Northwestern University Chicago Illinois USA
Abstract
AbstractBackgroundAlthough swallowing impairment is prevalent following lung transplantation, baseline respiratory and swallowing characteristics are often overlooked. Respiratory disease processes may predispose lung transplant candidates to altered respiratory‐swallow patterning and swallowing impairment.MethodsThis cross‐sectional study included patients referred for a Modified Barium Swallow Study during lung transplant evaluation. Swallowing impairment was measured using the Modified Barium Swallow Impairment Profile and Penetration‐Aspiration Scale. Respiratory plethysmographic signals synchronized with videofluoroscopy were analyzed to determine phase patterning, pause duration, and rate. Mixed‐effects logistic regression was used to identify linkages between respiratory and swallowing measures.Key ResultsFifty patients were included and demonstrated delayed swallow initiation (49/50), oral residue (37/50), incomplete pharyngoesophageal segment opening (35/50), and esophageal retention (43/50). Airway invasion occurred infrequently (10/50). Atypical respiratory patterning was significantly associated with impairment in pharyngeal swallow initiation (OR [95% CI] = 1.76 [1.16, 2.68], p = 0.009), laryngeal elevation (OR [95% CI] = 1.45 [1.01, 2.07], p = 0.044), and laryngeal vestibular closure (OR [95% CI] = 2.57 [1.48, 4.46], p < 0.001). Increased pause duration was associated with impaired initiation (OR [95% CI] = 2.24 [1.20, 4.16], p = 0.011), laryngeal elevation (OR [95% CI] = 1.18 [1.03, 1.36], p = 0.018), laryngeal closure (OR [95% CI] = 1.28 [1.9, 1.50], p = 0.003), and tongue base retraction (OR [95% CI] = 1.33 [1.13, 1.56], p < 0.001).Conclusions & InferencesPatients undergoing evaluation for lung transplant demonstrated impaired swallowing and phase patterning. Preliminary findings implicate the need for further evaluation of respiratory‐swallow coordination and its potential role in swallowing impairment before and after lung transplantation.