Quantifying pharyngeal residue across the adult life span (Garand et al., 2023)

Purpose: We quantified pharyngeal residue using pixel-based methods in a normative data set, while examining influences of age, gender, and swallow task. Method: One hundred ninety-five healthy participants underwent a videofluoroscopic swallow study following the Modified Barium Swallow Impairment Profile (MBSImP) protocol. ImageJ was used to compute Normalized Residue Ratio Scale and the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) pharyngeal residue measures. Reliability was established. Descriptive statistics were performed for all residue measures. Inferential statistics were performed using ASPEKT total scores (i.e., C2–42). Logistic regression models explored predictors of residue versus no residue. Generalized linear mixed models explored predictors of nonzero residue. Spearman rho explored relationships between ASPEKT total residue scores and MBSImP Component 16 (Pharyngeal Residue) scores. Results: Majority of swallows (1,165/1,528; 76.2%) had residue scores of zero. Residue presence (C2–42 > 0) was influenced by age (more in older [F = 9.908, p = .002]), gender (more in males [F = 18.70, p < .001]), viscosity (more in pudding, nectar, and honey [F = 25.30, p < .001]), and volume (more for cup sip [F = 37.430, p < .001]). When residue was present (363/1,528 = 23.8%), amounts were low (M = 1% of C2–42, SD = 2.4), and only increasing age was associated with increased residue (F = 9.008, p = .007) when controlling for gender and swallow task. Increasing residue was incremental (0.01% of C2–42 per year). As ASPEKT total residue values increased, MBSImP Component 16 scores also increased. Conclusions: Pharyngeal residue amounts were very low in healthy adults. Residue presence can be influenced by age, gender, and swallow task. However, when present, the amount of pharyngeal residue was only associated with increasing age. Supplemental Material S1. Normalized Residue Ratio Scale (NRRS) vallecular residue amounts between genders across age categories for each swallow task. Supplemental Material S2. Normalized Residue Ratio Scale (NRRS) pyriform sinus residue amounts between genders across age categories for each swallow task. Supplemental Material S3. Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) vallecular residue amounts between genders across age categories for each swallow task. Supplemental Material S4. Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) pyriform sinus residue amounts between genders across age categories for each swallow task. Supplemental Material S5. Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) other residue amounts between genders across age categories for each swallow task. Garand, K. L. (F.), Grissett, A., Corbett, M. M., Molfenter, S., Herzberg, E. G., Kim, H. J., & Choi, D. (2023). Quantifying pharyngeal residue across the adult life span: Normative values by age, gender, and swallow task. Journal of Speech, Language, and Hearing Research, 66(3), 820–831. https://doi.org/10.1044/2022_JSLHR-22-00413

研究目的：本研究基于像素分析法对标准化数据集的咽部残留物进行量化分析，同时考察年龄、性别以及吞咽任务的影响。
研究方法：共招募195名健康受试者，按照改良钡餐吞咽障碍评估量表（Modified Barium Swallow Impairment Profile, MBSImP）流程进行视频透视吞咽检查。采用ImageJ软件计算标准化残留物比值量表（Normalized Residue Ratio Scale, NRRS）以及吞咽生理学分析：事件、运动学与时序（Analysis of Swallowing Physiology: Events, Kinematics and Timing, ASPEKT）的咽部残留物量化指标。本研究确立了相关检测的信度，对所有残留物量化指标进行描述性统计分析；以ASPEKT总分（即C2–42）为变量开展推论统计分析；构建逻辑回归模型以探究残留物存在与否的预测因素；采用广义线性混合模型分析非零值残留物的预测因子；使用斯皮尔曼rho相关分析探讨ASPEKT总残留物评分与MBSImP组件16（咽部残留物）评分之间的相关性。
研究结果：在1528次吞咽动作中，绝大多数（1165次，占比76.2%）的残留物评分为0。残留物存在（C2–42＞0）受年龄、性别、食团黏度以及食团容量的影响：老年群体残留物检出率更高（F=9.908，p=0.002），男性群体残留物检出率更高（F=18.70，p＜0.001），布丁稠度、花蜜稠度与蜂蜜稠度食团的残留物检出率更高（F=25.30，p＜0.001），杯啜饮方式的食团残留物检出率更高（F=37.430，p＜0.001）。在存在残留物的363次吞咽（占总次数的23.8%）中，残留物含量普遍较低（平均值为C2–42的1%，标准差为2.4）；在控制性别与吞咽任务的条件下，仅年龄增长与残留物含量升高呈显著相关（F=9.008，p=0.007），且残留物含量随年龄呈递增趋势（每年增长C2–42的0.01%）。随着ASPEKT总残留物评分升高，MBSImP组件16的评分也随之升高。
研究结论：健康成人的咽部残留物含量普遍极低。残留物的存在与否受年龄、性别以及吞咽任务的影响，但当残留物存在时，其含量仅与年龄增长相关。
补充材料S1：各吞咽任务下不同年龄分层的两性间标准化残留物比值量表（NRRS）会厌谷残留物量。
补充材料S2：各吞咽任务下不同年龄分层的两性间标准化残留物比值量表（NRRS）梨状隐窝残留物量。
补充材料S3：各吞咽任务下不同年龄分层的两性间吞咽生理学分析：事件、运动学与时序（ASPEKT）会厌谷残留物量。
补充材料S4：各吞咽任务下不同年龄分层的两性间吞咽生理学分析：事件、运动学与时序（ASPEKT）梨状隐窝残留物量。
补充材料S5：各吞咽任务下不同年龄分层的两性间吞咽生理学分析：事件、运动学与时序（ASPEKT）其他类型残留物量。
Garand, K. L. (F.), Grissett, A., Corbett, M. M., Molfenter, S., Herzberg, E. G., Kim, H. J., & Choi, D. (2023). 成人生命周期内咽部残留物量化：基于年龄、性别与吞咽任务的标准化参考值. 《言语、语言与听力研究杂志》, 66(3), 820–831. https://doi.org/10.1044/2022_JSLHR-22-00413