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Surface electromyography as a screening method for evaluation of dysphagia and odynophagia.

Vaiman M, Eviatar E - Head Face Med (2009)

Bottom Line: SEMG is compared with other techniques in terms of cost, timing, involvement of radiation, etc.This noninvasive radiation-free examination has a low level of discomfort, and is simple, time-saving and inexpensive to perform.With standardization of the technique and an established normative database, sEMG might serve as a reliable screening method for optimal patient management but cannot serve for proper investigation of neurogenic dysphagia.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otolaryngology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel. vaimed@yahoo.com

ABSTRACT

Objective: Patients suspected of having swallowing disorders, could highly benefit from simple diagnostic screening before being referred to specialist evaluations. The article analyzes various instrumental methods of dysphagia assessment, introduces surface electromyography (sEMG) to carry out rapid assessment of such patients, and debates proposed suggestions for sEMG screening protocol in order to identify abnormal deglutition.

Data sources: Subject related books and articles from 1813 to 2007 were obtained through library search, MEDLINE (1949-2007) and EMBASE (1975-2007).

Methods: Specifics steps for establishing the protocol for applying the technique for screening purposes (e.g., evaluation of specific muscles), the requirements for diagnostic sEMG equipment, the sEMG technique itself, and defining the tests suitable for assessing deglutition (e.g., saliva, normal, and excessive swallows and uninterrupted drinking of water) are presented in detail. SEMG is compared with other techniques in terms of cost, timing, involvement of radiation, etc.

Results: According to the published data, SEMG of swallowing is a simple and reliable method for screening and preliminary differentiation among dysphagia and odynophagia of various origins. This noninvasive radiation-free examination has a low level of discomfort, and is simple, time-saving and inexpensive to perform. The major weakness of the method seems to be inability for precise diagnostic of neurologically induced dysphagia.

Conclusion: With standardization of the technique and an established normative database, sEMG might serve as a reliable screening method for optimal patient management but cannot serve for proper investigation of neurogenic dysphagia.

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Related in: MedlinePlus

Typical single swallows and drinking of a person with recurrent tonsillitis, age 24 years, (MS, SUB and INF locations). Trials 1–3 – saliva swallows, trials 4–6 – normal swallows, trial 7 – excessive swallow, trial 8 – 100 ml drinking. The SUB peaks are normal (blue line) except trial 1; MS peaks are somewhat high, especially in single swallows being almost similar to the SUB amplitude (green line), INF is very high compare to normal database (red line).
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Figure 4: Typical single swallows and drinking of a person with recurrent tonsillitis, age 24 years, (MS, SUB and INF locations). Trials 1–3 – saliva swallows, trials 4–6 – normal swallows, trial 7 – excessive swallow, trial 8 – 100 ml drinking. The SUB peaks are normal (blue line) except trial 1; MS peaks are somewhat high, especially in single swallows being almost similar to the SUB amplitude (green line), INF is very high compare to normal database (red line).

Mentions: Electric amplitude is also considered in the SEMG analysis. The range (amplitude, in μV) and mean of electric activity are less important for stage-by-stage evaluation of a SEMG recording [32-34]. These data might be useful, however, when abnormal swallows are investigated. For example, a person usually presents low electric activity at the MS location after undergoing a tooth extraction [39]. Patients with the Zenker's diverticulum present unusually high electric activity at the LSM location. The main sEMG patterns of Zenker's are: A) duration of swallowing and drinking is longer than normal; B) electric amplitude of laryngeal strap muscles during swallowing activity is higher than normal; C) regurgitation peaks immediately after swallow followed by secondary swallow of the regurgitated portion of a bolus as seen at the sEMG records are specific graphic patterns (Fig. 3) [44]. Patients with recurrent tonsillitis present abnormally high electric activity of LSM and infrahyoid muscles. Acute tonsillitis and recurrent tonsillitis affect muscle activity significantly by involving additional muscles (mainly infrahyoid) in swallowing (Fig. 4). Acute tonsillitis triggers temporary electric hyperactivity of LSM and infrahyoid muscles. Recurrent tonsillitis affects MS and infrahyoid even during periods of remission (fixed pathologic changes) [40-43]. There were also numerous reports of authors who indicated changes of the masseter electric activity in patients with diseases of temporomandibular joint [64-66].


Surface electromyography as a screening method for evaluation of dysphagia and odynophagia.

Vaiman M, Eviatar E - Head Face Med (2009)

Typical single swallows and drinking of a person with recurrent tonsillitis, age 24 years, (MS, SUB and INF locations). Trials 1–3 – saliva swallows, trials 4–6 – normal swallows, trial 7 – excessive swallow, trial 8 – 100 ml drinking. The SUB peaks are normal (blue line) except trial 1; MS peaks are somewhat high, especially in single swallows being almost similar to the SUB amplitude (green line), INF is very high compare to normal database (red line).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2654879&req=5

Figure 4: Typical single swallows and drinking of a person with recurrent tonsillitis, age 24 years, (MS, SUB and INF locations). Trials 1–3 – saliva swallows, trials 4–6 – normal swallows, trial 7 – excessive swallow, trial 8 – 100 ml drinking. The SUB peaks are normal (blue line) except trial 1; MS peaks are somewhat high, especially in single swallows being almost similar to the SUB amplitude (green line), INF is very high compare to normal database (red line).
Mentions: Electric amplitude is also considered in the SEMG analysis. The range (amplitude, in μV) and mean of electric activity are less important for stage-by-stage evaluation of a SEMG recording [32-34]. These data might be useful, however, when abnormal swallows are investigated. For example, a person usually presents low electric activity at the MS location after undergoing a tooth extraction [39]. Patients with the Zenker's diverticulum present unusually high electric activity at the LSM location. The main sEMG patterns of Zenker's are: A) duration of swallowing and drinking is longer than normal; B) electric amplitude of laryngeal strap muscles during swallowing activity is higher than normal; C) regurgitation peaks immediately after swallow followed by secondary swallow of the regurgitated portion of a bolus as seen at the sEMG records are specific graphic patterns (Fig. 3) [44]. Patients with recurrent tonsillitis present abnormally high electric activity of LSM and infrahyoid muscles. Acute tonsillitis and recurrent tonsillitis affect muscle activity significantly by involving additional muscles (mainly infrahyoid) in swallowing (Fig. 4). Acute tonsillitis triggers temporary electric hyperactivity of LSM and infrahyoid muscles. Recurrent tonsillitis affects MS and infrahyoid even during periods of remission (fixed pathologic changes) [40-43]. There were also numerous reports of authors who indicated changes of the masseter electric activity in patients with diseases of temporomandibular joint [64-66].

Bottom Line: SEMG is compared with other techniques in terms of cost, timing, involvement of radiation, etc.This noninvasive radiation-free examination has a low level of discomfort, and is simple, time-saving and inexpensive to perform.With standardization of the technique and an established normative database, sEMG might serve as a reliable screening method for optimal patient management but cannot serve for proper investigation of neurogenic dysphagia.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otolaryngology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel. vaimed@yahoo.com

ABSTRACT

Objective: Patients suspected of having swallowing disorders, could highly benefit from simple diagnostic screening before being referred to specialist evaluations. The article analyzes various instrumental methods of dysphagia assessment, introduces surface electromyography (sEMG) to carry out rapid assessment of such patients, and debates proposed suggestions for sEMG screening protocol in order to identify abnormal deglutition.

Data sources: Subject related books and articles from 1813 to 2007 were obtained through library search, MEDLINE (1949-2007) and EMBASE (1975-2007).

Methods: Specifics steps for establishing the protocol for applying the technique for screening purposes (e.g., evaluation of specific muscles), the requirements for diagnostic sEMG equipment, the sEMG technique itself, and defining the tests suitable for assessing deglutition (e.g., saliva, normal, and excessive swallows and uninterrupted drinking of water) are presented in detail. SEMG is compared with other techniques in terms of cost, timing, involvement of radiation, etc.

Results: According to the published data, SEMG of swallowing is a simple and reliable method for screening and preliminary differentiation among dysphagia and odynophagia of various origins. This noninvasive radiation-free examination has a low level of discomfort, and is simple, time-saving and inexpensive to perform. The major weakness of the method seems to be inability for precise diagnostic of neurologically induced dysphagia.

Conclusion: With standardization of the technique and an established normative database, sEMG might serve as a reliable screening method for optimal patient management but cannot serve for proper investigation of neurogenic dysphagia.

Show MeSH
Related in: MedlinePlus