Qualitative and quantitative analysis of oropharyngeal swallowing in Down syndrome

Sales, André Vinicius Marcondes Natel; Giacheti, Célia Maria; Cola, Paula Cristina; Silva, Roberta Gonçalves da

doi:10.1590/2317-1782/20172017005

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Case Report • CoDAS 29 (6) • 2017 • https://doi.org/10.1590/2317-1782/20172017005 linkcopy

Qualitative and quantitative analysis of oropharyngeal swallowing in Down syndrome

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose To describe the qualitative and quantitative temporal analysis of oropharyngeal swallowing in children diagnosed with Down syndrome (DS) through a case series study of six individuals aged 4 to 17 months (mean age = 11.16 months; median = 12 months).

Methods Qualitative and quantitative temporal analysis of swallowing using videofluoroscopy and specific software. The following parameters were assessed: presence or absence of oral incoordination, labial sphincter sealing incompetence, oral residue, posterior oral spillage, laryngotracheal penetration and aspiration, pharyngeal and total oral transit time (TOTT).

Results Qualitative analysis identified individuals with disorders in at least four of the swallowing parameters investigated. Only one individual presented total oral transit time (TOTT) different from the others. No difference was observed between the cases regarding pharyngeal transit time.

Conclusion Qualitative swallowing disorders are observed in children with DS, with difference in TOTT only in the case report of the youngest infant.

Keywords
Swallowing; Deglutition Disorders; Down syndrome; Fluoroscopy; Quantitative Analysis; Software

Case	Age	Gender	Clinical history
Case	Age	Gender	Swallowing complaints	Pulmonary complications	Gastroesophageal reflux	Cardiac conditions	Cardiac surgical intervention	Previous Speech-language therapy
1	1 to 5 months	Male	✔			✔		✔
2	1 to 2 months	Female		✔	✔	✔		✔
3	7 months	Male	✔	✔	✔			✔
4	1 to 3 months	Female		✔	✔	✔		✔
5	10 months	Female	✔	✔	✔	✔	✔	✔
6	4 months	Male	✔	✔	✔	✔		✔

Parameters	Description
Labial sphincter sealing incompetence	Incomplete occlusion between the lips and the nursing bottle nipple with or without presence of anterior oral spillage.
Oral incoordination	Incoordination of the oral structures along the anterior-to-posterior transit of the liquid bolus.
Oral residue	Contrasted material remains in the oral cavity after swallowing.
Posterior oral spillage	Presence of premature liquid escape to the hypopharynx, surpassing the region in which pharyngeal response should occur.
Laryngotracheal penetration	Presence of contrasted material in the laryngeal structures above the vocal folds⁽⁶⁾.
Laryngotracheal aspiration	Presence of contrasted material in the laryngeal structures below the vocal folds⁽⁶⁾.
Total oral transit time (TOTT)	Total oral transit time (TOTT) was described by Gatto et al.⁽⁸⁾ based on the definition of oral transit time (OTT) proposed by Logemann et al.⁽⁹⁾. TOTT was defined as an interval in milliseconds (ms) between the first frame showing the food inside the oral cavity and the first frame showing the head of the bolus in the end of hard palate and begin of soft palate (posterior nasal spine) and the point where the lower margin of the mandible ramus.
Pharyngeal transit time	Pharyngeal transit time (PTT) was defined based on Kendall et al.⁽¹⁰⁾. PTT begins in the first frame, and it is defined by the interval between the moment the head of the bolus passes the anterior nasal spine and the moment the tail of the bolus passes through the pharyngoesophageal sphincter, with time up to 1150 ms considered as normal⁽⁵⁾.

Case	Oral Phase				Pharyngeal Phase
Case	Oral incoordination	Labial sphincter sealing incompetence	Oral residue	Freq.	Posterior oral spillage	Laryngotracheal penetration	Laryngotracheal aspiration	Freq.
1	+	-	+	66.66%	+	+	-	66.66%
2	+	+	+	100%	-	-	-	0
3	+	+	+	100%	+	-	-	33.33%
4	+	+	+	100%	-	-	-	0
5	+	+	+	100%	+	+	-	66.66%
6	+	+	+	100%	+	+	+	100%
Freq.	100%	83.33%	100%		66.66%	50%	16.66%

Case	Frequency of qualitative parameters - Oral phase	Frequency of qualitative parameters - Pharyngeal phase	Total oral transit time in milliseconds	Pharyngeal transit time in milliseconds
1	+ +	+ +	680	600
2	+ + +		800	920
3	+ + +	+	550	750
4	+ + +		890	590
5	+ + +	+ +	800	720
6	+ + +	+ + +	2240*	440

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[1] Captions: ✔= present