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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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An example of a single swallow and normal drinking of 100 cc of water by a patient with severe throat problem (dysphagia and odynophagia due to tonsillectomy, second postoperative day, pain score 7). MS – masseter activity, SUB – submental activity, INF – infrahyoid activity. (In real EMG records these lines are of different colors). INF line is very high (normally this line is the lowest at the record), SUB line is lower than normal and almost similar to MS line. The single swallow is prolonged and done in two shares. Drinking is arrhythmic, swallows are small.
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Figure 5: An example of a single swallow and normal drinking of 100 cc of water by a patient with severe throat problem (dysphagia and odynophagia due to tonsillectomy, second postoperative day, pain score 7). MS – masseter activity, SUB – submental activity, INF – infrahyoid activity. (In real EMG records these lines are of different colors). INF line is very high (normally this line is the lowest at the record), SUB line is lower than normal and almost similar to MS line. The single swallow is prolonged and done in two shares. Drinking is arrhythmic, swallows are small.

Mentions: Surface EMG assessment of odynophagia also requires special attention. Pain is a subjective experience and one may argue that it is impossible to be assessed objectively. Partially this is correct. However, since Johann Bohn's (1686) observations of reflex movements in decapitated frogs, medical scientists are aware about muscular reactions on irritation of pain receptors. While pain is subjective in general, these muscle reactions are objective and EMG can provide us with qualitative and quantitative data for their assessment (Fig. 5) [39,42]. In fact, since electricity was introduced for diagnostic purposes by Duchenne de Boulogne in 1850s–70s, these muscular reactions to painful stimulation being studied before for neurophysiological purposes, gained additional clinical importance [78]. During this period of time and up to 1930s, however, Faradic current was used for muscle testing instead of non-irritating modern EMG [79]. It helped, for example, to improve the differential diagnosis between central and peripheral paralyses and attempts were made to investigate dysphagia after stroke [80]. But naturally, no screening methods were proposed, physicians' interest shifted to electrotherapy and further EMG investigation of dysphagia/odynophagia was delayed.


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

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

An example of a single swallow and normal drinking of 100 cc of water by a patient with severe throat problem (dysphagia and odynophagia due to tonsillectomy, second postoperative day, pain score 7). MS – masseter activity, SUB – submental activity, INF – infrahyoid activity. (In real EMG records these lines are of different colors). INF line is very high (normally this line is the lowest at the record), SUB line is lower than normal and almost similar to MS line. The single swallow is prolonged and done in two shares. Drinking is arrhythmic, swallows are small.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: An example of a single swallow and normal drinking of 100 cc of water by a patient with severe throat problem (dysphagia and odynophagia due to tonsillectomy, second postoperative day, pain score 7). MS – masseter activity, SUB – submental activity, INF – infrahyoid activity. (In real EMG records these lines are of different colors). INF line is very high (normally this line is the lowest at the record), SUB line is lower than normal and almost similar to MS line. The single swallow is prolonged and done in two shares. Drinking is arrhythmic, swallows are small.
Mentions: Surface EMG assessment of odynophagia also requires special attention. Pain is a subjective experience and one may argue that it is impossible to be assessed objectively. Partially this is correct. However, since Johann Bohn's (1686) observations of reflex movements in decapitated frogs, medical scientists are aware about muscular reactions on irritation of pain receptors. While pain is subjective in general, these muscle reactions are objective and EMG can provide us with qualitative and quantitative data for their assessment (Fig. 5) [39,42]. In fact, since electricity was introduced for diagnostic purposes by Duchenne de Boulogne in 1850s–70s, these muscular reactions to painful stimulation being studied before for neurophysiological purposes, gained additional clinical importance [78]. During this period of time and up to 1930s, however, Faradic current was used for muscle testing instead of non-irritating modern EMG [79]. It helped, for example, to improve the differential diagnosis between central and peripheral paralyses and attempts were made to investigate dysphagia after stroke [80]. But naturally, no screening methods were proposed, physicians' interest shifted to electrotherapy and further EMG investigation of dysphagia/odynophagia was delayed.

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