Application of Ultrasonography in Neurogenic Dysphagia: A Systematic Review
Dysphagia
Potente, P., Buoite Stella, A., et al. (2023).
Dysphagia, 38(1), 65-75.
<div>This systematic review investigates the usefulness of ultrasonography (US) in assessing neurogenic dysphagia in adults.</div>
Università degli Studi di Trieste (Italy)
From database inception to January 11, 2020
<div>Excludes reviews, meta-analyses, study protocols, case reports, letters to the editor, errata, and conference proceedings</div>
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<div>In adults with stroke in the acute phase, the use of US to measure hyoid-larynx approximation distance and degree demonstrated a significant association with the functional oral intake scale (FOIS) and the Gugging Swallow Screen (GUSS) clinical bedside screening measures. In both the acute and chronic phases, reduction in hyolaryngeal approximation as measured on US demonstrated good sensitivity and specificity for detecting dysphagia. In severely dysphagic, tube-feeding-dependent stroke patients, US detected tongue thickness changes and hyoid bone displacement during swallowing. The authors found that "US is an additional method that can be used to predict the need for tube feeding in severe dysphagia" (p. 69).</div>
<div>In adults with Parkinson's disease, two studies investigating US found that it "proved to be a useful tool to detect oropharyngeal dysfunction through the evaluation of time to hyoid-thyroid approximation" (p. 69).</div>
<div>In individuals with Duchenne or Becker muscular dystrophy (DMD/BMD), two studies investigating US measures found that tongue thickness and echo intensity of suprahyoid muscles (especially the digastricus and geniohyoid muscles) helped identify swallowing dysfunction. A gradual increase in tongue echo intensity measured by US correlated with reduced oral preparatory and oral phase durations with prepared solid foods. Particularly for patients with DMD/BMD, US identified early dystrophic changes in submental muscles and tongue, which can become more severe in later stages of DMD/BMD. The authors conclude that "early detection of chewing problems through a timely evaluation and repeated US follow-up of swallowing structures could be fundamental to prevent choking and nutritional deficiency, and aid clinicians to identify interventions" (p. 71).</div>
<div>One study comparing the validity of tongue US to videofluoroscopy (VF) in patients with amyotrophic lateral sclerosis (ALS) found that significantly lower tongue thickness (i.e., the distance between upper and lower surfaces of the lingual muscles) as measured on US demonstrated a significant association with increased oral preparation and transit time as measured on VF. Because US provided a non-invasive method for identifying tongue muscle fasciculation, the authors conclude that US "may have a supporting role in the diagnosing of ALS", particularly for early-stage fasciculations.</div>
