Exploring the relationship between age-related pharyngeal atrophy and difficulty swallowing.

 描述（由申请人提供）：安全有效的吞咽是大多数人认为理所当然的事情。然而，吞咽功能的破坏（吞咽困难）在衰老过程中并不罕见，并且可能对一个人的健康（营养，水合作用，肺炎）和生活质量产生严重后果。研究表明，老年人吞咽障碍的患病率范围为15- 74%，这取决于抽样人群和/或用于定义吞咽困难的指标。肌肉减少症是与年龄相关的骨骼肌质量、组织和强度的损失，并且是与年龄相关的吞咽功能下降的广泛引用的解释。我们最近的研究证实，年龄相关的肌肉损失发生在咽（喉咙），同时咽腔（喉腔）体积增加。尚不清楚咽部体积的增加如何影响吞咽生物力学和功能。本研究的长期目标是建立咽肌减少症（以较大的咽腔容积为代表）的程度与吞咽障碍之间的关系。该提议的中心假设是，较大的咽腔体积将与吞咽生物力学（咽部收缩和缩短）和功能（吞咽后残留物）受损相关。声反射技术（ART）的新应用将为无创测量咽腔容积提供创新方法。从睡眠科学和牙科研究中获得，ART功能类似于声纳。声波被引入口腔和喉咙，并被反射回麦克风。基于声反射，可以计算咽腔的表示。咽部容积的ART测量将与使用标准化视频荧光透视（VF）方案的吞咽生物力学和功能测量进行比较。该相同的VF方案还将产生数据以确定称为努力吞咽（ES）的咽部动作的功效，以改善吞咽生物力学和功能。我们期望发现，与来自同一个体的常规吞咽相比，ES改善了咽部收缩、咽部缩短和残留物的测量。这些数据将为未来使用ES对抗咽肌损失的基于运动的干预/预防研究提供基础。这一研究具有重要意义和及时性。随着我们人口的平均年龄迅速上升，了解吞咽机制的自然老化如何、何时以及为什么转变为吞咽障碍至关重要。预计这项工作将建立以下内容：（1）咽腔容积与吞咽生物力学和功能之间的反比关系，（2）ES改善吞咽生物力学和功能的效用，以及（3）ART监测咽中年龄相关变化的价值。总之，这将为咽肌减少症的预防/康复研究的未来计划提供信息。

 DESCRIPTION (provided by applicant): Safe and efficient swallowing is something that most people take for granted. However, a disruption to swallowing function (dysphagia) is not uncommon in the aging process and can have serious consequences for one's health (nutrition, hydration, pneumonia) and quality-of-life. Studies suggest that the prevalence of swallowing disorders in older individuals ranges from 15-74%, depending on the population sampled and/or the metric used to define dysphagia. Sarcopenia is the age-related loss of skeletal muscle mass, organization, and strength and is a widely-cited explanation for age-related decline in swallow function. Our recent research confirms that age-related muscle loss occurs in the pharynx (throat) alongside an associated increase in pharyngeal lumen (throat cavity) volume. It is unknown how this increase in pharyngeal volume impacts swallowing biomechanics and function. The long-term objective of this research is to establish a relationship between the extent of pharyngeal sarcopenia (represented by larger pharyngeal lumen volume) and swallowing impairment. The central hypothesis of this proposal is that greater pharyngeal lumen volume will be associated with impaired swallowing biomechanics (pharyngeal constriction and shortening) and function (post-swallow residue). A novel application of Acoustic Reflection Technology (ART) will provide the innovative method to non-invasively measure pharyngeal lumen volume. Adopted from sleep science and dental research, ART functions similar to sonar. Sound waves are introduced into the mouth and throat and are reflected back to a microphone. Based on the acoustic reflection, a representation of the pharyngeal lumen can be calculated. ART measures of pharyngeal volume will be compared with biomechanical and functional measures of swallowing using a standardized videofluoroscopy (VF) protocol. This same VF protocol will also yield the data to establish the efficacy of a pharyngeal maneuver, called the Effortful Swallow (ES), to improve swallowing biomechanics and function. We expect to find that the ES improves measures of pharyngeal constriction, pharyngeal shortening and residue compared with regular swallows from the same individual. This data will provide the foundation for a future exercise-based intervention/prevention study using the ES to combat pharyngeal muscle loss. The proposed research is significant and timely. As the mean age of our population rapidly shifts upwards, it is critical to understand how, when and why natural aging of the swallowing mechanism transforms into a swallowing disorder. It is anticipated that this work will establish the following; (1) an inverse relationship between pharyngeal lumen volume and swallowing biomechanics and function, (2) the utility of the ES to improve swallowing biomechanics and function and (3) the value of ART to monitor age- related change in the pharynx. Together this will inform a future program of research on the prevention/rehabilitation of pharyngeal sarcopenia.