{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:57:24Z","timestamp":1790744244225,"version":"4.1.0"},"reference-count":33,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: To investigate laryngeal elevation velocity (LEV) as a candidate physiological marker of swallowing safety in post-radiotherapy dysphagia patients with cricopharyngeal muscle dysfunction (CPMD), we examined its association with airway safety and whether the LEV\u2013upper esophageal sphincter (UES) opening relationship differed before versus after botulinum toxin injection, used here as a within-subject physiological perturbation. Methods: This retrospective cohort study included 18 post-radiotherapy patients with nasopharyngeal carcinoma (NPC) and CPMD who underwent botulinum toxin injection into the cricopharyngeal muscle (median total dose, 30 U; range, 20\u201340 U) and completed videofluoroscopic swallowing studies (VFSSs) before and after intervention. Primary outcomes were the Penetration\u2013Aspiration Scale (PAS) and UES opening diameter; secondary outcomes included the Functional Oral Intake Scale (FOIS), laryngeal elevation (LE) and LEV. Associations were evaluated using generalized estimating equations (GEEs) with LEV \u00d7 treatment interaction terms to assess whether they differed across pre- and post-injection states. Results: Following botulinum toxin injection, FOIS scores improved significantly (median, 4 to 5; p &lt; 0.001), with concurrent increases in LEV (median, 149.86 to 201.12 C2\u20134%\/s; p = 0.027) and UES diameter (median, 21.10 to 23.30 C2\u20134%; p = 0.039); PAS scores and laryngeal elevation displacement did not change significantly. Higher LEV was associated with lower odds of unsafe airway invasion (PAS 5\u20138) in univariate analysis (odds ratio per 100-unit increase, 0.38; 95% confidence interval [CI], 0.17\u20130.86; p = 0.021). A significant LEV \u00d7 treatment interaction was observed for UES diameter (p = 0.021). Conclusions: In post-radiotherapy NPC patients with CPMD, higher LEV was associated with airway safety, and the LEV\u2013UES relationship differed across pre- and post-injection states. Although the study design does not permit conclusions about treatment efficacy, LEV may represent a candidate load-sensitive marker of swallowing safety, warranting further investigation.<\/jats:p>","DOI":"10.3390\/jcm15197523","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:50:54Z","timestamp":1790614254000},"page":"7523","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Laryngeal Elevation Velocity as a Candidate Dynamic Marker of Swallowing Safety in Postradiotherapy Dysphagia: A Preliminary Exploratory Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9171-2376","authenticated-orcid":false,"given":"Kai-Hsiang","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Wei","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tammy","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan 701, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miyuki Hsing-Chun","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Jen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenn-Ren","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Chih","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Yen","family":"Ou","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chan-Chi","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Ting","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sen-Tien","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui-Chen","family":"Su","sequence":"additional","affiliation":[{"name":"Chewing and Swallowing Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Shang-Yu","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.radonc.2007.07.009","article-title":"Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: A dose-effect relationship","volume":"85","author":"Levendag","year":"2007","journal-title":"Radiother. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1177\/000348940010900315","article-title":"Dysphagia after radiotherapy: Endoscopic examination of swallowing in patients with nasopharyngeal carcinoma","volume":"109","author":"Wu","year":"2000","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1007\/s00455-013-9491-8","article-title":"Physiological changes to the swallowing mechanism following (chemo) radiotherapy for head and neck cancer: A systematic review","volume":"28","author":"Wall","year":"2013","journal-title":"Dysphagia"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s00066-018-01421-6","article-title":"Radiotherapy-induced dysphagia and its impact on quality of life in patients with nasopharyngeal carcinoma","volume":"195","author":"Li","year":"2019","journal-title":"Strahlenther. Onkol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s00455-013-9500-y","article-title":"Changes in swallowing physiology and patient perception of swallowing function following chemoradiation for head and neck cancer","volume":"29","author":"Pierce","year":"2014","journal-title":"Dysphagia"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Zhang, J., Zhou, Y., Wei, N., Yang, B., Wang, A., Zhou, H., Zhao, X., Wang, Y., Liu, L., and Ouyoung, M. (2016). Laryngeal elevation velocity and aspiration in acute ischemic stroke patients. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0162257"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Omari, T.I., Wiklendt, L., Dinning, P., Costa, M., Rommel, N., and Cock, C. (2015). Upper esophageal sphincter mechanical states analysis: A novel methodology to describe UES relaxation and opening. Front. Syst. Neurosci., 8.","DOI":"10.3389\/fnsys.2014.00241"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1007\/s00455-016-9744-4","article-title":"Modulation of upper esophageal sphincter (UES) relaxation and opening during volume swallowing","volume":"32","author":"Cock","year":"2017","journal-title":"Dysphagia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1053\/gast.1997.v113.pm9352847","article-title":"Impaired deglutitive airway protection: A videofluoroscopic analysis of severity and mechanism","volume":"113","author":"Kahrilas","year":"1997","journal-title":"Gastroenterology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"046013","DOI":"10.1088\/1741-2560\/10\/4\/046013","article-title":"Laryngeal elevation by selective stimulation of the hypoglossal nerve","volume":"10","author":"Hadley","year":"2013","journal-title":"J. Neural Eng."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1007\/s00455-019-10067-0","article-title":"Impaired movement scaling and reduced synchrony with vestibule closure characterize swallowing in severe dysphagia","volume":"35","author":"Wong","year":"2020","journal-title":"Dysphagia"},{"key":"ref_12","unstructured":"Casilli, S. (2024). The Relationship Between UES Distension and Laryngeal Shortening. [Master\u2019s Thesis, University of Pittsburgh]."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"125","DOI":"10.2147\/CIA.S152821","article-title":"High-speed jaw-opening exercise in training suprahyoid fast-twitch muscle fibers","volume":"13","author":"Matsubara","year":"2018","journal-title":"Clin. Interv. Aging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1097\/00005537-200007000-00016","article-title":"Efficacy of botulinum toxin A for treatment of upper esophageal sphincter dysfunction","volume":"110","author":"Alberty","year":"2000","journal-title":"Laryngoscope"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"G359","DOI":"10.1152\/ajpgi.00388.2015","article-title":"Predicting the activation states of the muscles governing upper esophageal sphincter relaxation and opening","volume":"310","author":"Omari","year":"2016","journal-title":"Am. J. Physiol. Gastrointest. Liver Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s11894-017-0552-2","article-title":"Diagnosis of swallowing disorders: How we interpret pharyngeal manometry","volume":"19","author":"Cock","year":"2017","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s00455-025-10868-6","article-title":"The Effectiveness of Botulinum Toxin Injection for Cricopharyngeal Dysfunction-Related Dysphagia in Nasopharyngeal Carcinoma Patients","volume":"41","author":"Hu","year":"2025","journal-title":"Dysphagia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"G909","DOI":"10.1152\/ajpgi.00473.2011","article-title":"Upper esophageal sphincter impedance as a marker of sphincter opening diameter","volume":"302","author":"Omari","year":"2012","journal-title":"Am. J. Physiol. Gastrointest. Liver Physiol."},{"key":"ref_19","unstructured":"Iwano, M., Saitoh, E., Kagaya, H., Onogi, K., Inamoto, Y., Shibata, S., and Akahori, R. (2019). Balloon Catheter. (WO Patent WO2019107308A1)."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"87","DOI":"10.11336\/jjcrs.5.87","article-title":"Immediate effectiveness of balloon dilatation therapy for patients with dysphagia due to cricopharyngeal dysfunction","volume":"5","author":"Onogi","year":"2014","journal-title":"Jpn. J. Compr. Rehabil. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1177\/0003489417745091","article-title":"Steering sheath for 2-nostril Transnasal office laryngoscopy","volume":"127","author":"Hoffman","year":"2018","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1590\/S0004-28032010000400001","article-title":"Videofluoroscopy: The gold standard exam for studying swallowing and its dysfunction","volume":"47","author":"Costa","year":"2010","journal-title":"Arq. Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1038\/ejcn.2017.100","article-title":"Prevalence and clinical correlation of dysphagia in Parkinson disease: A study on Chinese patients","volume":"72","author":"Ding","year":"2018","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/j.apmr.2004.11.049","article-title":"Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients","volume":"86","author":"Crary","year":"2005","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1007\/s00455-017-9809-z","article-title":"Reflections on clinical and statistical use of the penetration-aspiration scale","volume":"32","author":"Steele","year":"2017","journal-title":"Dysphagia"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s00455-019-10064-3","article-title":"Use of the penetration-aspiration scale in dysphagia research: A systematic review","volume":"35","author":"Borders","year":"2020","journal-title":"Dysphagia"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1044\/2014_JSLHR-S-13-0152","article-title":"Use of an anatomical scalar to control for sex-based size differences in measures of hyoid excursion during swallowing","volume":"57","author":"Molfenter","year":"2014","journal-title":"J. Speech Lang. Hear. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1109\/JTEHM.2023.3246919","article-title":"Non-Invasive Sensor-Based Estimation of Anterior-Posterior Upper Esophageal Sphincter Opening Maximal Distension","volume":"11","author":"Khalifa","year":"2023","journal-title":"IEEE J. Transl. Eng. Health Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1007\/s40141-016-0134-5","article-title":"To cough or not to cough? Examining the potential utility of cough testing in the clinical evaluation of swallowing","volume":"4","author":"Watts","year":"2016","journal-title":"Curr. Phys. Med. Rehabil. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1002\/lary.26854","article-title":"Evaluation of the natural history of patients who aspirate","volume":"127","author":"Bock","year":"2017","journal-title":"Laryngoscope"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Pekacka-Egli, A.M., Kazmierski, R., Lutz, D., Pekacka-Falkowska, K., Maszczyk, A., Windisch, W., and Spielmanns, M. (2021). Reassessment of poststroke dysphagia in rehabilitation facility results in reduction in diet restrictions. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081714"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1007\/s00455-024-10677-3","article-title":"Dysphagia in Open Partial Horizontal Laryngectomy Type IIa: Quantitative Analysis of Videofluoroscopy using the ASPEKT Method","volume":"39","author":"Cerqueira","year":"2024","journal-title":"Dysphagia"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s00455-021-10267-7","article-title":"Impact of thickened liquids on laryngeal movement velocity in patients with dysphagia","volume":"37","author":"Nakao","year":"2022","journal-title":"Dysphagia"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7523\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:17:53Z","timestamp":1790741873000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7523"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,27]]},"references-count":33,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197523"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197523","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,27]]}}}