Comparison of electromyography, sound, bioimpedance, and high-resolution manometry for differentiating swallowing and vocalization events

Miho Ohashi; Yoichiro Aoyagi; Satoshi Ito; Hitoshi Kagaya; Masatoshi Hirata; Seiichi Nakata

doi:10.1016/j.medengphy.2023.103980

Comparison of electromyography, sound, bioimpedance, and high-resolution manometry for differentiating swallowing and vocalization events

Med Eng Phys. 2023 May:115:103980. doi: 10.1016/j.medengphy.2023.103980. Epub 2023 Apr 10.

Authors

Miho Ohashi¹, Yoichiro Aoyagi², Satoshi Ito³, Hitoshi Kagaya⁴, Masatoshi Hirata⁵, Seiichi Nakata³

Affiliations

¹ Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan.
² Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan. Electronic address: yyy@rc5.so-net.ne.jp.
³ Department of Otorhinolaryngology and Sleep Medicine, School of Medicine, Fujita Health University, Nagoya, Japan.
⁴ Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.
⁵ Department of Clinical Laboratory, Fujita Health University Bantane Hospital, Nagoya, Japan.

PMID: 37120175
DOI: 10.1016/j.medengphy.2023.103980

Abstract

Objectives: Non-invasive surface recording devices used for detecting swallowing events include electromyography (EMG), sound, and bioimpedance. However, to our knowledge there are no comparative studies in which these waveforms were recorded simultaneously. We assessed the accuracy and efficiency of high-resolution manometry (HRM) topography, EMG, sound, and bioimpedance waveforms, for identifying swallowing events.

Methods: Six participants randomly performed saliva swallow or vocalization of "ah" 62 times. Pharyngeal pressure data were obtained using an HRM catheter. EMG, sound, and bioimpedance data were recorded using surface devices on the neck. Six examiners independently judged whether the four measurement tools indicated a saliva swallow or vocalization. Statistical analyses included the Cochrane's Q test with Bonferroni correction and the Fleiss' kappa coefficient.

Results: Classification accuracy was significantly different between the four measurement methods (P < 0.001). The highest classification accuracy was for HRM topography (>99%), followed by sound and bioimpedance waveforms (98%), then EMG waveform (97%). The Fleiss' kappa value was highest for HRM topography, followed by bioimpedance, sound, and then EMG waveforms. Classification accuracy of the EMG waveform showed the greatest difference between certified otorhinolaryngologists (experienced examiners) and non-physicians (naive examiners).

Conclusion: HRM, EMG, sound, and bioimpedance have fairly reliable discrimination capabilities for swallowing and non-swallowing events. User experience with EMG may increase identification and interrater reliability. Non-invasive sound, bioimpedance, and EMG are potential methods for counting swallowing events in screening for dysphagia, although further study is needed.

Keywords: Bioimpedance; Electromyography; High-resolution manometry; Sound; Swallowing.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Deglutition Disorders* / diagnosis
Deglutition*
Electromyography
Humans
Manometry / methods
Reproducibility of Results