Improving Diagnostic Standards in Dysphagia
Condition: Dysphagia
MeSH terms: Deglutition Disorders
Study type: Observational

Summary: 
      The purpose of this research is to understand the normal function of swallowing and
      respiratory muscles in order to establish normal parameters. This will allow us to compare
      normal physiology and function of swallowing and breathing muscles to people with a medical
      history that would put them at risk for a swallowing problem. Our goal is to identify the
      best tests that can be quickly and easily administered to accurately detect swallowing
      impairment in adults. Involvement is limited to a single 2-hour evaluation.
    

Detailed description: 
      The purpose of this research is to understand the normal function of swallowing and
      respiratory muscles in order to establish normal parameters. It will take approximately
      90-120 minutes to complete. During this examination, you will have respiratory testing, cough
      testing, lingual testing, voice testing, and will be asked to fill out some surveys. We will
      then complete the swallowing test that uses both a moving x-ray and a small camera will be
      inserted into the open passage of your nose to the back of your throat to watch your swallow
      and look at your vocal folds (voice box). This will allow us to compare normal physiology and
      function of swallowing and breathing muscles to people with a medical history that would put
      them at risk for a swallowing problem. Our goal is to identify the best tests that can be
      quickly and easily administered to accurately detect swallowing impairment in adults. Your
      involvement is limited to a single 2-hour evaluation.
    

Intervention name(s): Fiberoptic Endoscopic Evaluation of Swallowing; Videofluoroscopic Swallowing Study; Voluntary Peak Cough Flow Testing; Iowa Oral Performance Instrument; Capsaicin Challenge; Pulmonary Function Testing; Voicing Tasks
Intervention type(s): Procedure; Procedure; Procedure; Procedure; Procedure; Procedure; Other
Intervention description(s): This procedure involves inserting a flexible laryngoscope that contains a light source and video camera on the end through the open passage of the nose towards the back of the throat in order to visualize the swallowing mechanism.; Videofluoroscopic swallowing study will be performed to measure oropharyngeal swallowing. This is like a moving x-ray of the swallow.; Voluntary peak cough flow testing will be performed to determine the peak expiratory flow (PEF) and volume of air expelled (FEV1) during voluntary coughing.; The Iowa Oral Performance Instrument (IOPI) is a device that measures the peak pressure performance of lingual strength and endurance via the action of a bulb placed on the hard palate.; A capsaicin challenge with three randomized blocks of 0, 50, 100, 200, and 500 μM capsaicin. The capsaicin will be dissolved in a vehicle solution consisting of 80% physiological saline, and 20% ethanol. Participants will be given the instruction "cough if you need to" prior to capsaicin delivery.The solution will be administered automatically upon detection of an inspired breath and there will be a minimum of one minute between each trial. This is to test the reflexive cough testing for upper airway sensitivity and motor thresholds.; Pulmonary Function testing will be performed using conventional methods and will include the following outcomes: forced vital capacity (FVC), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) expressed as a percentage of predicted values.; Voicing tasks will be completed to assess vocal ability.
Other intervention name(s): (FEES); Reflexive Cough Testing
Intervention MeSH terms: Capsaicin
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Healthy Cohort:

        132 individuals with no history of swallowing impairment or any health conditions known to
        impact swallowing function will be included in this study to serve as a comparative control
        group or reference standard group here and in future studies.

        Disordered Cohort:

        132 individuals with an underlying condition documented to lead to dysphagia will be
        enrolled in this study.
      
Keywords: Dysphagia; Peak Cough Flow (PCF); Swallowing; Respiration