title: Fiber-optic endoscopic evaluation of swallowing to assess swallowing outcomes as a function of head position in a normal population.
abstract: BACKGROUND
  Head position practice has been shown to influence pill-swallowing ability, but the impact of head position on measures of swallowing outcomes has not yet been studied with fiber-optic endoscopic evaluation of swallowing (FEES). The primary purpose of this study was to determine whether head position impacts penetration-aspiration scale scores and/or post-swallow pharyngeal residue as assessed by FEES. Documenting the incidence of pharyngeal residue and laryngeal penetration and aspiration in a normal population was a secondary goal.
  
  
  METHODS
  Adults without swallowing difficulties (N = 84) were taught a pill swallowing technique based on learning five head positions and were asked to practice with small, hard candies (e.g., TicTacs) for two weeks. Then they demonstrated swallowing in each of the head positions for two conditions, liquid and purée, while undergoing FEES.
  
  
  RESULTS
  Out of 840 examined swallows, one event of aspiration and 5 events of penetration occurred. During practice >50% participants found positions they preferred over the center position for swallowing but head position was not associated with penetration-aspiration scores assessed by FEES. Significant associations and non-significant trends were found between pharyngeal residue and three variables: age, most preferred head position, and least preferred head position.
  
  
  CONCLUSIONS
  Head position during swallowing (head up) and age greater than 40 years may result in increased pharyngeal residue but not laryngeal penetration or aspiration.
authors.forename: Lucas A
authors.initials: LA
authors.lastname: Badenduck
authors.affiliation: Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. wmatthew@ucalgary.ca.
authors.forename: T Wayne
authors.initials: TW
authors.lastname: Matthews
authors.forename: Alanna
authors.initials: A
authors.lastname: McDonough
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Dort
authors.forename: Kristin
authors.initials: K
authors.lastname: Wiens
authors.forename: Rachelle
authors.initials: R
authors.lastname: Kettner
authors.forename: Susan
authors.initials: S
authors.lastname: Crawford
authors.forename: Bonnie J
authors.initials: BJ
authors.lastname: Kaplan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003679:Deglutition / Q000502:physiology*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005336:Fiber Optic Technology; D019416:Head Movements / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000503:physiopathology*; D011187:Posture / Q000502:physiology*; D012016:Reference Values; D053120:Respiratory Aspiration / Q000503:physiopathology*; D012307:Risk Factors; D014741:Video Recording; D055815:Young Adult
references.citation: Ann Otol Rhinol Laryngol. 2009 Feb;118(2):99-106
references.pmid: 19326759
references.citation: Laryngoscope. 2000 Apr;110(4):563-74
references.pmid: 10764000
references.citation: Paediatr Child Health. 2010 May;15(5):e1-5
references.pmid: 21532781
references.citation: Ann Otol Rhinol Laryngol. 1998 Apr;107(4):344-8
references.pmid: 9557771
references.citation: Otolaryngol Head Neck Surg. 1994 Feb;110(2):222-7
references.pmid: 8108157
references.citation: J Dev Behav Pediatr. 1991 Aug;12(4):229-35
references.pmid: 1939677
references.citation: Dysphagia. 1996 Spring;11(2):93-8
references.pmid: 8721066
references.citation: J Appl Physiol (1985). 2009 Jun;106(6):1848-57
references.pmid: 19325027
references.citation: Biometrics. 2000 Sep;56(3):893-6
references.pmid: 10985233
references.citation: Arch Phys Med Rehabil. 1989 Oct;70(10):767-71
references.pmid: 2802957
references.citation: Dysphagia. 1993;8(1):1-6
references.pmid: 8436016
references.citation: Clin Pediatr (Phila). 2006 Oct;45(8):725-33
references.pmid: 16968958