Hyoid movement during swallowing in older patients with dysphagia.

OBJECTIVES To describe the timing, coordination, and extent of hyoid movement in a population of older adults with dysphagia and to evaluate the effect 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. Analysis of the effect of hyoid movement on upper esophageal sphincter opening was performed using contingency tables. RESULTS In an older population with dysphagia, the coordination of swallowing gestures and bolus timing was intact, hyoid elevation was slow, and the duration of maximal hyoid elevation was reduced, but appropriate for the age of the patients. The hyoid bone elevated farther than normal for small bolus sizes, but the patients were unable to maintain this strategy in larger bolus swallows. CONCLUSION An increased extent of hyoid displacement in older patients with dysphagia may represent a necessary compensation designed to minimize the effect of the short duration of hyoid elevation on the upper esophageal sphincter opening.