Modeling and analyzing the acoustic signatures of human swallowing mechanism

吞咽是人体最复杂的动作之一。即使吞咽事件的顺序稍有延迟或不匹配，也可能使食物吸入肺部，并引起明显的发病率和死亡率。特别是在老年人和残疾患者中，中风、头颈或脊髓损伤，吞咽障碍是相当常见的。为了评估吞咽障碍，通常在进食期间用特殊的x射线（视频透视）观察患者。由于我们最近的研究显示吞咽声音分析有很好的诊断能力，我们建议在这里研究使用声学分析来评估吞咽的其他方法。利用现有的食管压力测量数据与视频透视图像和吞咽声音相对应，我们将建立一个吞咽机制的综合结构模型，并对特定吞咽事件的声学特征进行建模。我们将用健康受试者和患者的数据验证和测试我们的模型。我们假设模型的一些参数，即那些代表肌肉力量或结构运动之间的时间的参数，在两组之间会有显著差异，从而提供了一种客观探索吞咽障碍原因的手段。我们还建议开发一个集成和模块化系统的原型，以获取，去噪，分析和筛选吞咽和呼吸声音信号，并使用无线技术将数据传输到远程临床诊断中心。本文提出的工作将简化相关的临床评估，并有助于更好地了解吞咽功能障碍。此外，这项工作将提供客观的手段来帮助医生确定吞咽困难患者的哪些缺陷需要解决和治疗。我们提出的计划将有助于建立加拿大在令人兴奋和迅速扩大的远程医疗领域，特别是吞咽机制的声学分析，并将直接受益于每个人。

Swallowing is among the most complicated acts of the human body.  Even a slight delay or mismatch in the sequence of swallowing events may allow food aspiration into the lung and causes appreciable morbidity and mortality.  Especially in the elderly and in patients with disabilities, stroke, head-neck or spinal cord injuries, swallowing disorders are quite common. To assess swallowing disorders, patients are generally observed with a special X-ray (videofluroscopy) during feeding. Since our recent studies have shown promising diagnostic capabilities of swallowing sound analysis, we propose here to investigate other methods for swallowing assessment using acoustical analysis. Using available manometry data of the esophageal pressure in correspondence to videoflouroscopic images and swallowing sounds, we will develop a comprehensive structural model for the swallowing mechanism and model the acoustic signatures of specific swallowing events. We will validate and test our model with data obtained in both healthy subjects and patients. We hypothesize that some of the model's parameters, i.e. those that represent the muscle force or the timing between structural movements, will be significantly different between the two groups, and hence provide a means to explore objectively the cause of swallowing disorders. We also propose to develop a prototype of an integrated and modular system to acquire, denoise, analyze, and screen swallowing and breath sound signals, and to use wireless technology to transfer data to a remote clinical diagnostic center.The work proposed here will simplify relevant clinical assessments and contribute to better understanding of swallowing dysfunction.  Also, this work will provide objective means to aid physicians in determining which deficiency in the dysphagic patient needs to be addressed and treated.  Our proposed program will contribute to establishing Canada in the exciting and rapidly expanding field of telemedicine in general, and acoustical analysis of swallowing mechanisms in particular, and will directly benefit everyone involved.