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1 Comparison of the Passage Velocity of Various Foods in the Human Pharynx by Ultrasonic Measurement Akira NAGATOISHI, Osamu NOGUCHI, Chieko ITou, Hiroaki Tsuji, Akiko MORITA * and Fumiko NAKAZAWA Research Laboratory, The Nisshin Oil Mills Ltd., Yokosuka Faculty of Home Economics, Kyoritsu Women's University, Hachioji The passage velocity of various types of food in the pharynx when healthy individuals swallowed was measured by the ultrasonic pulse Doppler method in order to clarify the relationship between the rheological property of each type of food and the relative difficulty of aspiration. The food types tested were divided into two categories; one comprised food that patients with dysphagia could aspirate easily (EA category) and the other comprised food that was more difficult to aspirate (DA category). The mean velocity (VMEAN), maximum velocity (VMAX), degree of velocity dispersion (spectrum area: SA), and the time for swallowing (ST) in the pharynx were compared between the two food categories. As a result, VMEAN and VMAX values for each food in the DA category were significantly lower, while SA was significantly lower than each food in the EA category (p ƒ 0.01). ST was (s), but bore no relationship with the difficulty of aspiration. The food in the EA category was statistically distinguishable from that in the DA category by a cluster analysis. The results show a close relationship between the passage velocity of food in the pharynx and the difficulty of aspiration to the trachea for the food. (Received March 27, 2000; Accepted in revised form February 2, 2001)
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3 Fig. 1. The three phases of normal swallowing )4 )10) The measurement point, direction of ultrasonic pulse, and food flow are indicated. (a) Hard palate, (b) tongue, (c) hyoid bone, (d) thyroid cartilage, (e) trachea, (f) nasal cavity, (g) soft palate, (h) epiglottis, (i) esophagus. Fig. 2. Measurement system Fig. 3. View of the experiment The probe was set at an upward angle of 20 against the neck. It was positioned against the upper part of the collarbone, and its right and left positions were set in accordance with the B mode figure.
4 日 Direction Fig. 4. of ultrasonic Cross section 本易政学会誌 Vol.52 No,4 (2001) pulse of the cervix" TR, trachea; ES, esophagus; CA, carotid artery. The region marked in yellow is used in Figs. and Ii. Fig. O. Colored image Doppler and the oolong tal:en by the net hod in the velocity spectrum ultrasonic pulse measurement region when swallowing tea ES, esophagus; CA, carotid iirniry. 時 間. を示 す. (3) 師品の 追 薩 と 呉1文 去 水,お 茶 な ど の サ ラサ ラ した 液 体 や キ ザ ミ食,硬 の 寒 天 ゲ ル な ど は,食 と言 わ れ て い る.こ れ に 対 し ヨー グ ル ト,ブ リ ン,軟 ら か く調 製 し た ゼ ラ チ ン ゼ リ ー,及 び増 粘 剤 等 で トロ ミをつ け た 液 体 等 は 川.嚇しゃ す く,ま Fig. G. Colored Doppler (luring image taken method deep by the ultrasonic in the measurement pulse region め 塊 が 形 成 し に く く誤 嚥 しや す い と ま りが あ り, の ど ご しの よ い 食 品 な の で 誤 嚥 しに くい と言 わ れ て い る3)4), breathing Table 1に 評 した 食品 とそ の 摂 取 方 法 を示 した. TR, trachea; CA. carotid artery. 誤 嚥 しや す い 食 品 と し て ウー ロ ン 茶 と 硬 め の 寒 天 ゲ ル 度 を示 す. す い と さ れ る 水 な どの 代 表 と し て 選 択 し た.寒 を 選 択 した.ウ 2) 最 高 速 度(VMAX,m/s):-12dB値 の最 高値 燕下 した 食 品 が 喉 頭 蓋を 部 を通 過 す る 時 の 最 高 速 は 添 加 甲:0.8%の 誤 嚥 しに くい 食 品 と して,ゼ ス ペ ク トル 面 積(SA)= S2 増 粘 剤 液,ヨ S2は 該 当 部 分 の ピ クセ ル 数 を カ ウ ン ト して 得 ら れ た面 積 の 大 き さ を 表 す 数 値 だ が,流 " c"の 速 ス ペ ク トル は, 内 側 す べ て の 部 分 に 粒子 が 分 布 して い る 中 抜 け が な い)の で,速 硬 め の ゲ ル を 調 製 して,ス 度 の バ ラ ツ キ の 指 標 と して 使 用 は 添 加 冠2%の 天ゲル 粘 剤 液 は 添 加 冠306で カ ス タ ー ド ク リー ム 状 に トロ ミを つ け て,そ の ま ま飲 み 込 ん だ. 全 粥 及 び 圧分 粥 は 叫 頭 蓋下 部 を通 過 す る時 の 速 度 の バ ラ ツ キ 度 合 い を 示 す. 飲 み 込 ん だ. (ST)=t を して,あ る程 度食塊 形 成 し の 他 はTable 1に 示 し た 通 り に (4) 測 定 及 び デ ー タ処 理 嚥 ドし た 食 品 の 喉 頭 壽下 部 を 通 過 す る の に 要 し た 42 リ ン, ラチ ンゲル 軟 らか め の ゲ ル を 調 製 して,寒 て か ら飲 み 込 ん だ.そ 嚥下時間 ラ チ ンゲ ル,ブ ー グ ル ト,粥 を 選 択 した.ゼ と 同 様 の 方 法 で 飲 み 込 ん だ.増 で き る と 考 え ら れ る す な わ ち, 嚥下 した 食 品 が 喉 4) 天ゲ ル プ ー ンで 潰 した 状 態 で 飲 み 込 ん だ. 度 の 指 標 とす る. 3) ー ロ ン 茶 は 嚥下 困 難 打 が 最 も誤 嚥 しや 被 験 者 は 健 常 男 性2名 (346 ) でTable 2に 体 格 の 詳 細 を 示
5 Fig. 7. Relationship between the velocity, time and brightness in the velocity spectrum A: Relationship between time and velocity. B: Velocity distribution (brightness-velocity relationship) at a given time. B shows three kinds of values for the velocity distribution at the given time in A: average value (mean), mode value (mode) and -12 db intensive value (-12 db). a: line connecting "mean" at each time; b: line connecting -12 db" at each time; c: outline of the velocity spectrum; Si: area under line "a," S2: area under line "c," t: time from the start of line "c" to the end. Fig. 8. Examples of the velocity spectrum for each sample swallowed by the same subject The vertical axis indicates the velocity (m/s) and the horizontal axis indicates the time (s).
6 Table 1. Food samples measured by the ultrasonic pulse Doppler method Jellied tea 0.8% agar, *2 jellied tea 2% gelatin, *3 oolong tea with added thickener (3%), rice:water= 1:6, *5 rice:water= 1:8, * 6 jelly strength (reometer: 15 mmy3, 6 cm/min, 15 Ž), viscosity (BM type, No.4, 30 rpm, 25 Ž), *8viscosity (BM type, No. 3, 12 rpm, 15 Ž), *9 viscosity (BH type, No. 7, 4 rpm, 30t). Table 2. Physical features of the subjects
7 a: Mean Velocity (ratio) b: Maximum Velocity (ratio) c: Spectrum Area (ratio) d: Swallowinff Time (ratio) Fig. 9. Ratio of the measured value obtained for each food sample to that of oolong tea (n = 6 0 )
8 Fig. 10. Result of the cluster analysis The foods in the EA category (oolong tea and agar gel (hard)) were statistically distinguished from the foods in the DA category by cluster analysis using 4 parameters (ratio of VMEAN, VMAX, SA and ST).
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