Ann Rehabil Med.  2020 Jun;44(3):203-209. 10.5535/arm.19140.

Changes in Pharyngeal Width Over Time as an Indicator of Dysphagia in Stroke Patients

• Baek S
• Jung IH
• Lee HY
• Song J
• Cha E
• Jung KI
• Yoo WK
• Ohn SH

• KMID: 2504440
• DOI: http://doi.org/10.5535/arm.19140

Abstract

Objective
To verify the pharyngeal width at rest as a measurement that could be used to assess changes in the degree of dysphagia over time in stroke patients.
Methods
In a cohort of stroke patients, we performed serial measurements of the pharyngeal width at the midpoints of the second (C2) and third (C3) cervical vertebral bodies using lateral neck X-rays while the patients were at rest. The JOSCYL width, a parameter named after the first initial of each developers’ surname and defined as the average value of the upper and lower pharyngeal widths, was used to formulate the JOSCYL scale, which was calculated as the JOSCYL width × 100/neck circumference. All patients also underwent serial videofluoroscopic swallowing studies (VFSSs). The Spearman correlation analysis was used to detect correlations between the serial VFSS results, JOSCYL widths, and JOSCYL scale values.
Results
Over time, we observed significant positive and negative correlations of change in the JOSCYL width and scale with changes in the Penetration-Aspiration Scale and the Dysphagia Outcome and Severity Scale scores, respectively.
Conclusion
The JOSCYL width and JOSCYL scale clearly reflected changes in dysphagia in stroke patients over time. These parameters may provide an easier method for evaluating whether post-stroke dysphagia has been alleviated.

Keyword

Pharynx; Deglutition disorder; Respiratory aspiration; Stroke

Figure

• 

  Fig. 1. Flow chart of the analytical process. Lateral cervical spine X-rays were taken prior to the videofluoroscopic swallowing study (VFSS), which used three types of materials with different viscosities. PAS, Penetration-Aspiration Scale; DOSS, Dysphagia Outcome and Severity Scale.

• 

  Fig. 2. Determination of the JOSCYL width on the cervical X-ray. This value was calculated as the average of two pharyngeal widths, A and B. The perpendicular lines A and B originated from the posterior pharyngeal wall at the positions corresponding to the midpoints of the second and third cervical vertebral bodies, respectively. Lines A and B were positioned around the lower margin of the mandible and around the epiglottis, respectively.

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  Fig. 3. Analysis of correlations between changes in the JOSCYL width (A) and JOSCYL scale (B) over time and changes in the dysphagia scale scores over time. The JOSCYL width and scale correlated positively with the Penetration-Aspiration Scale (PAS) scores and negatively with the Dysphagia Outcome and Severity Scale (DOSS) scores over time. All correlations were significant.

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