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Biomedical subjects

B C Sonies

Publications and source records attributed to B C Sonies.

At least 37 records · Page 2Linked to original sources
PubMed1992

Oropharyngeal dysphagia in the elderly.

Considerable evidence exists to suggest that normal aging alone does not cause significant impairment to the ability to swallow. Although there are changes in muscular tension, speed of responses, taste sensitivity, and smell, the physiology of swallowing remains relatively intact. There is evidence suggesting that the duration of the oropharyngeal swallow is longer in older females and that esophageal motility slows in normal aging. Elderly persons do produce multiple lingual gestures and may eat softer and less spicy foods. These changes are subtle and subclinical but do not indicate oropharyngeal dysphagia. Oropharyngeal dysphagia in the elderly is the specific result of a pathologic condition or illness that may occur more commonly in elderly persons. These conditions are neurologic, neuromuscular, systemic, immunologic, psychiatric, environmental, or societal in nature. Oropharyngeal dysphagia is commonly found in institutionalized elderly populations and presents an ethical dilemma in treatment.

Aged↗
PubMed1991

Dysphagia in patients with the post-polio syndrome.

BACKGROUND AND METHODS: Dysphagia may develop in some patients many years after an attack of acute paralytic poliomyelitis. To identify clinical or subclinical signs of oropharyngeal dysfunction, we examined 32 patients (mean age, 48.9 years) with the post-polio syndrome (defined by new weakness in the limbs). Of the 32 patients, 14 had symptoms of new swallowing difficulties, and 18 were asymptomatic in this respect; 12 had a history of bulbar involvement during acute poliomyelitis. Swallowing function was assessed objectively by ultrasonography, videofluoroscopy, and an oral motor index score for 10 components of oral function. RESULTS: All but 1 of the 32 patients, regardless of whether they had new symptoms or previous bulbar involvement, had some abnormality on detailed testing of oropharyngeal function; only 2 patients had any signs of aspiration. The mean oral motor index score (a quantitative measure of oral sensorimotor function) in the patients was higher than that in age-matched normal subjects (P less than 0.001). Videofluoroscopy showed abnormalities of varying severity, including unilateral bolus transport through the pharynx, pooling in the valleculae or pyriform sinuses, delayed pharyngeal constriction, and impaired tongue movements. On ultrasonography, the mean (+/- SD) duration of wet swallows was significantly longer in the symptomatic patients than in the asymptomatic patients (2.67 +/- 0.70 vs. 1.65 +/- 0.42 seconds). The four patients who were reexamined two years later had objective signs of worsening oropharyngeal function and corresponding new symptoms. CONCLUSIONS: In patients with the post-polio syndrome, the bulbar muscles often have clinical or subclinical signs of dysfunction. These abnormalities suggest that in bulbar neurons there is a slowly progressive deterioration similar to that in the muscles of the limbs.

Adult↗
PubMed1990

Swallowing dysfunction in nephropathic cystinosis.

BACKGROUND: Nephropathic cystinosis causes renal failure in most patients at approximately 10 years of age. This can be prevented or retarded by cystine-depleting therapy with oral cysteamine. Many patients who do not receive adequate cysteamine therapy undergo renal transplantation, but the accumulation of cystine continues in other organs, resulting in various clinical abnormalities. We report age-related swallowing dysfunction in patients with nephropathic cystinosis. METHODS: We studied 43 patients with cystinosis (24 who had received a renal transplant and 19 who had not), 3 to 31 years of age. Oral motor function was assessed by a cranial-nerve oral sensorimotor examination, and an oral motor index was calculated for each patient. The oral phase of swallowing was assessed by ultrasonography, and the pharyngeal and esophageal phases were evaluated by videofluoroscopy. RESULTS: Approximately half the patients were slow eaters. Oral motor dysfunction, reflected by a higher oral motor index, increased with age. Speech, oral structure and anatomy, and tongue and lip strength were particularly affected. Seven of nine patients 21 to 31 years old had abnormalities in all three phases of swallowing; the deficits were variable in younger patients. In 28 patients with cystinosis, the mean (+/- SD) duration of oropharyngeal swallowing for a dry swallow (3.06 +/- 1.06 seconds) was longer than in 14 normal subjects (1.89 +/- 0.57 seconds; P less than 0.001). This prolongation reflected impairment of the initiation phase of swallowing. CONCLUSIONS: Swallowing dysfunction is a late complication of nephropathic cystinosis, probably related to muscular dysfunction. Changes in the consistency of foods, swallowing exercises, and long-term cysteamine therapy should be considered for patients with cystinosis who have difficulty in swallowing.

Adolescent↗
PubMed1989

Relationship between saliva production and oropharyngeal swallow in healthy, different-aged adults.

We have evaluated the possible relationship between major salivary gland fluid secretion rate and characteristics of the oral phase of swallowing in 35 different-aged, healthy men and women. All subjects displayed normal function of the parotid and submandibular glands and oral swallow patterns on ultrasound evaluation that were comparable to previous reports. In this study group we found no significant relationships between salivary flow rates (unstimulated, stimulated) and any oral swallow measure. Evidence of a subtle, age-related oral motor change (multiple hyoid and tongue gestures) was seen but swallow duration times did not show a linear relationship to age. This study demonstrates that healthy individuals, despite a wide range in their salivary gland fluid secretory capacity, are generally similar in the characteristics of their oropharyngeal swallow.

Adult↗
PubMed1989

Objective measures of swallowing in patients with primary Sjogren's syndrome.

Primary Sjogren's syndrome (SS) is an autoimmune disorder primarily affecting salivary and lacrimal glands. Durational measures of the oral phase of swallowing were obtained on 34 patients with primary SS and 34 age-matched controls from analyses of ultrasound scans. Two conditions were examined: a basal (BA) swallow (only endogeneous secretions present in the subjects' mouths) and a 10 ml water bolus (WB) swallow. The patients with SS produced swallowing durations significantly longer (p less than 0.05) than those of the controls for each of the two conditions. Moreover, unlike normals, over 40% of the patients with SS produced WB swallows that were longer than their BA swallows. For further analyses, patients with SS were classified into two groups based on the difference in duration between their BA and WB swallows. These two groups differed from each other on clinical evaluations of oral motor function and presenting complaints. No significant differences were found between these two groups for salivary function or immunologic profile. These findings support the hypothesis that dysphagia can result from conditions leading to salivary gland dysfunction and document the need for the assessment of swallowing function in patients with Sjogren's syndrome.

Adult↗
PubMed1989

Dysphagia in bulimia nervosa.

The findings on 13 patients with bulimia nervosa referred for evaluation of salivary glands and swallowing patterns are presented. Each patient completed a medical, oral, and social history questionnaire. A complete oral examination supported by appropriate dental radiographs and photographs was conducted. Unstimulated and stimulated parotid and submandibular saliva was collected. The presence or absence of pharyngeal and velar gag reflexes was ascertained. Real-time ultrasound scanning and barium swallow studies were used to evaluate the oral-motor functions while swallowing on 6 of the subjects. Activity of the pharynx, larynx, and esophagus was recorded during the videofluorographic studies. Saliva concentrations of amylase were determined in the referred subjects as well as 13 age-matched healthy controls. No significant difference was detected between the salivary gland flow rates and amylase concentrations of the two groups, whether stimulated or unstimulated. The pharyngeal gag reflex was absent in 9 of the 13 bulimic patients and a velar gag reflex could be elicited in only 1. All of the normal controls had both gag reflexes. All of the patients with bulimia were found to have abnormal oropharyngeal swallow patterns and an increased duration of dry swallow.

Adolescent↗
PubMed1988

Evaluation of swallowing pathophysiology.

A description of the variety of diagnostic techniques used to study dysphagia is presented. The advantages and limitations of each are discussed along with a description of how each procedure evaluates the actual components of swallowing, both normal and abnormal. Diagnostic decision points in the course of diagnosis and treatment and discussed.

Deglutition↗
PubMed1985

Xerostomia: evaluation of a symptom with increasing significance.

Xerostomia is the subjective sensation of oral dryness. Although it is most commonly associated with salivary gland dysfunction, it may also occur with normal gland activity. Xerostomia may be an early symptom of several morbid systemic conditions with important implications for the medical and dental management of patients. Oral dryness also has negative effects on an individual's emotional well-being and quality of life. The complaint of xerostomia necessitates a complete evaluation of a patient's general health, salivary gland function, and oral motor and sensory abilities. The salivary gland assessment includes symptom review, analysis of glandular secretions, scintiscanning, and minor labial gland biopsy. No single component is sufficient to adequately diagnose the presence, extent, or cause of salivary dysfunction. Treatment of a dry mouth, to date, is mainly palliative in nature, with the intent of preserving oral structures and functions. Better therapies are essential in the management of xerostomia, whatever the cause. The importance of xerostomia as a symptom is increasingly recognized in medicine and dentistry. The dentist is commonly the first health professional to hear this complaint and may be critical in directing a full and appropriate evaluation.

Adult↗
PubMed1984

Soft tissue anatomy of the tongue and floor of the mouth: an ultrasound demonstration.

Ultrasound technology has not been used extensively in the study of normal and abnormal oral physiology and speech. Features such as soft tissue detail, real-time motion display, and subject safety make ultrasound ideal for imaging the tongue and the floor of the mouth. This study demonstrates visualization of the muscles of the tongue and floor of the mouth for a normal subject using ultrasound imaging. By employing submandibular transducer placement of realtime sector scanners, tongue anatomy and motion were continuously visualized in sagittal or coronal planes. In addition to the entire tongue surface, much of the intrinsic anatomy was identified including: the genioglossus, geniohyoid, mylohyoid, and digastric muscles; fascial boundaries such as the median fibrous septum, floor intermuscular septum, and paramedian septums; and the hyoid bone. A tongue excised from a human cadaver was scanned using ultrasound and dissected to confirm the anatomy seen in the live tongue. Tongue surface shape and configuration of the intrinsic tissue structures were observed and compared for the phonemes /k/, /u/, and /i/. Anatomical landmarks in the resting and speaking tongue are discussed as well as applications in the fields of speech science and speech pathology.

Adult↗
PubMed1984

Tongue motion in elderly adults: initial in situ observations.

By using ultrasound, a noninvasive imaging technique, we were able to compare tongue motion at rest and during speech production and resting tongue thickness in normal older and younger adults. Three sounds /i/, /a/, and /k/ were studied as representative of the basic patterns of tongue displacement during speaking. Midline sagittal tracings of tongue surface curvature were measured to determine thickness, degree, and direction of tongue displacement at rest and during phonation of the three sounds. Differences in direction and extent of tongue displacement were significant between young and old adults during production of /a/ but not /i/ or /k/. Older persons showed a significant diminution in tongue thickness during rest. We found no evidence that tongue function was affected. Ultrasound imaging thus appears to be a useful method for evaluating certain oral-motor functions during aging.

Adult↗
PubMed1984

Characterization of tongue shape.

Mathematical techniques are described for analyzing tongue shapes obtained with ultrasound images. The surface of the mid-sagittal section of the tongue was approximated by discrete points. In turn, these points were used to approximate position, slope and curvature of the tongue surface at a fixed time during speech. Two approaches were employed. The first method involved the use of finite difference approximations to derivatives of the function of tongue position. The second utilized a curve fit. Both methods were examined for reliability. Results of these analyses on a simple, single speech sound are discussed.

Humans↗
PubMed1981

Ultrasonic visualization of tongue motion during speech.

A real-time ultrasonic imaging system has been developed to visualize dynamic motions of the tongue during continuous speech. Lingual motion configurations are displayed and recorded synchronously with the speech signal, time in milliseconds, and frontal and lateral views of the face during articulation. All data are videotaped and stored permanently for analysis. Data on the vertical movement of the tongue surface was obtained on 30 normal adult speakers. This technique seems to provide a useful, noninvasive technique for quantifying tongue position during speech utterances and possibly has potential as a clinical tool.

Adult↗
PubMedDate not supplied

Tongue movement during speech: a real-time ultrasound evaluation.

Tongue movement during production of the speech sounds /a/, /i/, and /k/ was examined with a real-time sector scanner positioned submentally. With this technique, it is possible to obtain excellent visualization of the tongue surface and to identify much of the intrinsic soft tissue anatomy of the tongue and floor of the mouth. Tongue movement and configuration were found to be consistent for 10 normal speakers, especially for /i/ and /k/. Three patients with neurological disease and dysarthria showed varying but significant differences in articulation compared to normals. It appears that real-time ultrasound imaging of the oral cavity is a potentially valuable technique for the clinical investigation of normal and abnormal speech.

Adult↗