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

 描述(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，吞咽功能的中断(吞咽困难)在衰老过程中并不少见，并可能对一个人的健康(营养、水分、肺炎)和生活质量造成严重后果。研究表明，老年人吞咽障碍的患病率从15%到74%不等，这取决于抽样的人群和/或用来定义吞咽困难的指标。骨质疏松症是与年龄相关的骨骼肌质量、组织和力量的丧失，是与年龄相关的吞咽功能下降的一种被广泛引用的解释。我们最近的研究证实，与年龄相关的肌肉损失发生在咽部(喉咙)，同时伴随着咽腔(喉腔)体积的增加。目前尚不清楚咽容量的增加如何影响吞咽的生物力学和功能。这项研究的长期目标是确定咽部石棺减少的程度(以较大的咽腔体积表示)和吞咽障碍之间的关系。这一建议的中心假设是，咽腔容量较大与吞咽生物力学(咽部收缩和缩短)和功能(吞咽后残留物)受损有关。声反射技术(ART)的一种新应用将为无创测量咽腔体积提供新的方法。ART采用了睡眠科学和牙科研究，其功能类似于声纳。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。咽部容量的ART测量将与使用标准化视频透视(VF)方案的吞咽的生物力学和功能测量进行比较。同样的VF方案也将产生数据，以确定咽部动作的有效性，称为用力吞咽(ES)，以改善吞咽生物力学和功能。我们期望发现，与来自同一个体的普通燕子相比，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对抗咽部肌肉损失的基于运动的干预/预防研究提供基础。提出的研究具有重要的意义和及时的意义。随着我们人口的平均年龄迅速上升，理解吞咽机制的自然衰老如何、何时以及为什么转变为吞咽障碍是至关重要的。预计这项工作将建立以下方面：(1)咽腔体积与吞咽生物力学和功能之间的反向关系，(2)ES改善吞咽生物力学和功能的效用，以及(3)ART监测咽部年龄相关变化的价值。总之，这将为未来预防/康复咽部石棺减少症的研究计划提供信息。

 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.