Laryngeal Elevation Velocity as a Candidate Dynamic Marker of Swallowing Safety in Postradiotherapy Dysphagia: A Preliminary Exploratory Study.
5 affiliations
- 1Department of Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
- 2Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
- 3Department of Otolaryngology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan 701, Taiwan.
- 4Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
- 5Chewing and Swallowing Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
Abstract
Background/Objectives: To investigate laryngeal elevation velocity (LEV) as a candidate physiological marker of swallowing safety in post-radiotherapy dysphagia patients with cricopharyngeal muscle dysfunction (CPMD), we examined its association with airway safety and whether the LEV-upper esophageal sphincter (UES) opening relationship differed before versus after botulinum toxin injection, used here as a within-subject physiological perturbation. Methods: This retrospective cohort study included 18 post-radiotherapy patients with nasopharyngeal carcinoma (NPC) and CPMD who underwent botulinum toxin injection into the cricopharyngeal muscle (median total dose, 30 U; range, 20-40 U) and completed videofluoroscopic swallowing studies (VFSSs) before and after intervention. Primary outcomes were the Penetration-Aspiration Scale (PAS) and UES opening diameter; secondary outcomes included the Functional Oral Intake Scale (FOIS), laryngeal elevation (LE) and LEV. Associations were evaluated using generalized estimating equations (GEEs) with LEV × treatment interaction terms to assess whether they differed across pre- and post-injection states. Results: Following botulinum toxin injection, FOIS scores improved significantly (median, 4 to 5; p < 0.001), with concurrent increases in LEV (median, 149.86 to 201.12 C2-4%/s; p = 0.027) and UES diameter (median, 21.10 to 23.30 C2-4%; p = 0.039); PAS scores and laryngeal elevation displacement did not change significantly. Higher LEV was associated with lower odds of unsafe airway invasion (PAS 5-8) in univariate analysis (odds ratio per 100-unit increase, 0.38; 95% confidence interval [CI], 0.17-0.86; p = 0.021). A significant LEV × treatment interaction was observed for UES diameter (p = 0.021). Conclusions: In post-radiotherapy NPC patients with CPMD, higher LEV was associated with airway safety, and the LEV-UES relationship differed across pre- and post-injection states. Although the study design does not permit conclusions about treatment efficacy, LEV may represent a candidate load-sensitive marker of swallowing safety, warranting further investigation.
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BibTeX
@article{hu2026laryngeal,
title = {{Laryngeal Elevation Velocity as a Candidate Dynamic Marker of Swallowing Safety in Postradiotherapy Dysphagia: A Preliminary Exploratory Study.}},
author = {Kai-Hsiang Hu and Shu-Wei Tsai and Tammy Tsai and Miyuki Hsing-Chun Hsieh and Yi-Jen Chen and Jenn-Ren Hsiao and Cheng-Chih Huang and Chun-Yen Ou and Chan-Chi Chang and Wei-Ting Lee and Sen-Tien Tsai and Hui-Chen Su and David Shang-Yu Hung},
journal = {Journal of clinical medicine},
year = {2026},
month = sep,
doi = {10.3390/jcm15197523},
url = {https://europepmc.org/article/MED/42881986},
note = {CC BY},
}
RIS
TY - JOUR
TI - Laryngeal Elevation Velocity as a Candidate Dynamic Marker of Swallowing Safety in Postradiotherapy Dysphagia: A Preliminary Exploratory Study.
AU - Kai-Hsiang Hu
AU - Shu-Wei Tsai
AU - Tammy Tsai
AU - Miyuki Hsing-Chun Hsieh
AU - Yi-Jen Chen
AU - Jenn-Ren Hsiao
AU - Cheng-Chih Huang
AU - Chun-Yen Ou
AU - Chan-Chi Chang
AU - Wei-Ting Lee
AU - Sen-Tien Tsai
AU - Hui-Chen Su
AU - David Shang-Yu Hung
PY - 2026
DA - 2026/09/27
JO - Journal of clinical medicine
DO - 10.3390/jcm15197523
UR - https://europepmc.org/article/MED/42881986
AB - Background/Objectives: To investigate laryngeal elevation velocity (LEV) as a candidate physiological marker of swallowing safety in post-radiotherapy dysphagia patients with cricopharyngeal muscle dysfunction (CPMD), we examined its association with airway safety and whether the LEV-upper esophageal sphincter (UES) opening relationship differed before versus after botulinum toxin injection, used here as a within-subject physiological perturbation. Methods: This retrospective cohort study included 18 post-radiotherapy patients with nasopharyngeal carcinoma (NPC) and CPMD who underwent botulinum toxin injection into the cricopharyngeal muscle (median total dose, 30 U; range, 20-40 U) and completed videofluoroscopic swallowing studies (VFSSs) before and after intervention. Primary outcomes were the Penetration-Aspiration Scale (PAS) and UES opening diameter; secondary outcomes included the Functional Oral Intake Scale (FOIS), laryngeal elevation (LE) and LEV. Associations were evaluated using generalized estimating equations (GEEs) with LEV × treatment interaction terms to assess whether they differed across pre- and post-injection states. Results: Following botulinum toxin injection, FOIS scores improved significantly (median, 4 to 5; p < 0.001), with concurrent increases in LEV (median, 149.86 to 201.12 C2-4%/s; p = 0.027) and UES diameter (median, 21.10 to 23.30 C2-4%; p = 0.039); PAS scores and laryngeal elevation displacement did not change significantly. Higher LEV was associated with lower odds of unsafe airway invasion (PAS 5-8) in univariate analysis (odds ratio per 100-unit increase, 0.38; 95% confidence interval [CI], 0.17-0.86; p = 0.021). A significant LEV × treatment interaction was observed for UES diameter (p = 0.021). Conclusions: In post-radiotherapy NPC patients with CPMD, higher LEV was associated with airway safety, and the LEV-UES relationship differed across pre- and post-injection states. Although the study design does not permit conclusions about treatment efficacy, LEV may represent a candidate load-sensitive marker of swallowing safety, warranting further investigation.
SN - 2077-0383
ER -