Hyoid movement during swallowing in older patients with dysphagia

Objectives: To describe the timing, coordination, and extent of hyoid movem ent in a population of older adults with dysphagia and to evaluate the effe ct of hyoid movement on upper esophageal sphincter opening. Design: A retrospective review of dynamic swallow studies performed between January 1996 and December 1999 was done. Subjects: Patients included in the study were 65 years or older, without an obvious medical or surgical cause for their dysphagia. Timing and distance measures of hyoid movement from the patient population were compared with those from 60 younger (range, 18-62 years) and 23 older (range 67-83 years) control subjects without dysphagia using 1-way analysis of variance. Analy sis of the effect of hyoid movement on upper esophageal sphincter opening w as performed using contingency tables. Results: In an older population with dysphagia, the coordination of swallow ing gestures and bolus timing was intact, hyoid elevation was slow, and the duration of maximal hyoid elevation was reduced, but appropriate for the a ge of the patients. The hyoid bone elevated farther than normal for small b olus sizes, but the patients were unable to maintain this strategy in large r bolus swallows. Conclusion: An increased extent of hyoid displacement in older patients wit h dysphagia may represent a necessary compensation designed to minimize the effect of the short duration of hyoid elevation on the upper esophageal sp hincter opening.