Search Results (24)

Background: This study aimed to investigate the association between occlusal splint use and several key parameters, including body position perception, tongue pressure, temporomandibular joint dysfunction (TMD) severity, jaw functional limitation, and neck muscle endurance. Methods: A total of 157 individuals diagnosed with bruxism were screened, and 52 eligible participants were enrolled and divided into two groups: occlusal splint users (n = 26) and non-users (n = 26). Body position perception was assessed with a digital inclinometer, tongue pressure was measured using the Iowa Oral Performance Instrument (IOPI), and neck muscle endurance was evaluated by the Cranio-Cervical Flexion Test (CCFT). TMD severity and jaw functional limitation were assessed via the Fonseca Anamnestic Questionnaire and Jaw Functional Limitation Scale-20, respectively. Gender-based analyses showed higher TMD severity and mandibular limitation scores in females using occlusal splints than in males. Results: No statistically significant differences were found between the splint and non-splint groups in body position perception, tongue pressure and neck muscle endurance (p > 0.05). However, significant differences were observed in the Jaw Functional Limitation Scale (CFKS) subscales. Splint users reported higher functional limitations in chewing, mobility, and expression compared to non-splint users (all p = 0.000), with small effect sizes (d = 0.23–0.29). Conclusions: Occlusal splint use was not associated with better proprioception, orofacial muscle function, or TMD-related symptoms compared with non-splint users. However, splint users were associated with higher mandibular functional limitation based on CFKS subscale scores. Full article

(1) Background: The Iowa Oral Performance Instrument (IOPI) is the well-established device for assessing tongue strength. The current study aimed to assess the effectiveness of the HEAL device in patients with obstructive sleep apnea (OSA) exhibiting varying degrees of tongue base obstruction, as determined by drug-induced sleep endoscopy (DISE). All participants had undergone modified uvulopalatopharyngoplasty (UPPP), and tongue strength was measured using the IOPI. (2) Methods: This retrospective observational study utilized DISE to assess patterns of upper airway collapse in patients with OSA who were candidates for surgical intervention. Based on DISE findings, patients were divided into two groups: the M group (no or partial tongue base obstruction) and the S group (severe obstruction). The first tongue strength assessment using the IOPI was conducted one month after modified UPPP, prior to initiating HEAL training. Patients then underwent tongue muscle training with the HEAL device, starting one-month post-surgery. A second IOPI assessment was performed after at least one month of training. (3) Results: Forty-nine OSA patients with varying degrees of tongue base obstruction (assessed via DISE) received modified UPPP and were included in the analysis. The mean age was 38.3 ± 7.4 years, and mean BMI was 27.8 ± 3.9 kg/m². After training with the HEAL, average tongue strength increased by 20.6 ± 11.5 kPa. The M group showed significantly greater improvement than the S group (22.45 ± 11.77 vs. 13.33 ± 6.93 kPa, p = 0.024). Linear regression confirmed this difference remained significant (p = 0.024). (4) Conclusions: In this study, participants who received modified UPPP exhibited improvements in tongue base strength following a minimum of one month of training with the HEAL device. Those with no or mild tongue base obstruction, as determined by DISE prior to surgery, experienced greater improvements in tongue strength compared to those with severe tongue base obstruction. Full article

Objective: Accurate measurement of orofacial muscle strength is essential for phenotyping patients with obstructive sleep apnea (OSA), and particularly those with hypotonic phenotypes. High costs associated with gold standard devices such as the Iowa Oral Performance Instrument (IOPI^®) limit their clinical use. This study aims to validate the Sandway^® manometer, a low-cost alternative to the IOPI^®, by comparing its performance against the IOPI^® and the Tongue Digital Spoon (TDS) in both laboratory and clinical settings. Methods: We conducted a two-phase study. In the laboratory phase, pressure readings from the IOPI^® and Sandway^® devices were compared using standardized force application methods. In the clinical phase, 60 patients with moderate-to-severe untreated OSA underwent orofacial strength evaluation using IOPI^®, Sandway^®, and TDS devices. Intraclass Correlation Coefficient (ICC), Bland–Altman analysis, and Pearson correlation were used to assess reliability and agreement. Results: The Sandway^® showed excellent reliability for anterior tongue and lip strength measures (ICC = 0.978). Bland–Altman plots revealed minimal bias and narrow limits of agreement compared to the IOPI^®, indicating strong agreement for both tongue and lip measurements. A high correlation was also observed between Sandway^® and TDS results (r = 0.863, p < 0.001), supporting secondary validation. Conclusions: The Sandway^® manometer demonstrates high reliability and strong agreement with gold standard instruments, representing a valid, accessible alternative for objective assessment of orofacial muscle strength in clinical practice. Full article

Background: Spinal muscular atrophy (SMA) is a neuromuscular disorder that frequently affects bulbar function, including feeding and swallowing. Although disease-modifying therapies have improved motor outcomes, little is known about the persistence of oromotor difficulties, particularly with regard to solid food intake. Objective: This study aimed to evaluate mastication and swallowing performance in children with SMA undergoing treatment, and to investigate the association between tongue strength and feeding efficiency. Methods: Twenty-two children with SMA types 1–3 were assessed using the Test of Masticating and Swallowing Solids in Children (TOMASS-C) and the Iowa Oral Performance Instrument (IOPI). Key TOMASS-C outcomes included the number of bites, chewing cycles, swallows, and total eating time. Tongue strength was measured in kilopascals. Results: Most participants showed deviations from age-specific normative values in at least one TOMASS-C parameter. Tongue strength was significantly lower than reference values in 86% of participants and correlated negatively with all TOMASS-C outcomes (p < 0.001). Children with weaker tongue pressure required more swallows, more chewing cycles, and longer eating times. Conclusions: Despite pharmacological treatment, children with SMA experience persistent difficulties in eating solid foods. Tongue strength may serve as a non-invasive biomarker for bulbar dysfunction and support dietary decision-making and therapeutic planning. Full article

Background: Myofunctional therapy has emerged as a treatment option for obstructive sleep apnea (OSA). The Iowa Oral Performance Instrument (IOPI) enables objective measurement of lingual and orofacial muscle strength, although it was originally designed for evaluating dysphagia. OSA is frequently associated with a hypotonic phenotype characterized by reduced strength in upper airway muscles, but its identification remains unclear. Objective: We evaluated the usefulness of IOPI measurements in identifying hypotonic phenotypes among patients with obstructive sleep apnea (OSA). Methods: We carried out a cross-sectional study analyzing the relationship between IOPI scores, sleep polygraphy metrics—such as the apnea–hypopnea index (AHI)—and findings from physical examination. In addition to the standard IOPI protocol, we introduced novel maneuvers aimed at providing a more comprehensive assessment of oropharyngeal muscle function. Results: Although IOPI conventional maneuvers showed no clear association with AHI or ODI, the inferior tongue maneuver showed higher awake tongue strength, with a statistically significant correlation to both AHI (r = 0.2873; p = 0.008) and ODI (r = 0.2495; p = 0.032). Performing each exercise three times yielded highly consistent results across trials (r > 0.94), but did not significantly alter the overall outcome. Interestingly, lower tongue strength values were observed in patients with a high-arched palate (p < 0.05), whereas no relevant associations were found with the presence of a restricted lingual frenulum or CPAP use. Conclusions: Incorporating specific IOPI maneuvers, especially the inferior tongue exercise, may provide additional insight into muscle function in OSA. Selective repetition is advisable for borderline values. Full article

Background and Objectives: Sufficient evidence supports the Iowa Oral Performance Instrument (IOPI) as a reliable tool for measuring tongue strength and endurance as well as an effective assessment instrument for intervention studies. This study aimed to investigate the impact of a tongue training device, the HEAL, on tongue muscle strength in patients with obstructive sleep apnea (OSA) following modified uvulopalatopharyngoplasty (UPPP), utilizing the IOPI for evaluation. Materials and Methods: We introduced a tongue strengthener, the HEAL, made from medical-grade silicone, designed to improve tongue strength. Each patient was provided with the HEAL and instructed to begin using it one month after undergoing modified UPPP for OSA. The tongue strength of OSA patients was measured using the IOPI both before using the HEAL and approximately 6 weeks later. Results: A total of 66 participants with OSA underwent modified UPPP and were included in the final analysis. The mean age was 39.15 ± 8.84 years, and the mean BMI was 27.41 ± 4.03 kg/m². The duration between the pre- and post-assessment of tongue strength using the HEAL was 42.95 ± 17.97 days. The mean tongue strength pressure before and after using the HEAL was 32.16 ± 16.00 kilopascals (kPa) and 42.95 ± 17.97 kPa, respectively. Tongue strength increased by an average of approximately 52.8% after using the HEAL for an approximate duration of 6 weeks. Conclusions: In the current study, participants with OSA who had undergone modified UPPP and subsequently used the HEAL demonstrated an average improvement of 10.79 kPa in tongue strength—an increase of over 50%—as measured by the IOPI. The interval between the pre- and post-assessment of tongue strength was approximately six weeks. Further studies are needed to validate these findings. Full article

Most previous studies on orofacial muscle strength have focused on older adults with conditions associated with sensorimotor deficits, such as stroke. However, the modifiable oral health factors that directly impact orofacial muscle strength and swallowing ability in healthy older adults remain unexplored. This pilot study explored the potential factors associated with orofacial muscle strength, particularly oral health conditions, in 70 healthy adults aged ≥65 years living independently without any diseases that cause dysphagia or sensorimotor deficits. The Iowa Oral Performance Instrument (IOPI) was used to assess orofacial muscle strength (tongue elevation, and cheek and lip compression). Statistical analyses were conducted using an independent t-test, one-way ANOVA, and multivariate linear regression. In the final regression models after adjustment, older age and fewer remaining teeth were significantly associated with reduced tongue and cheek strengths (p < 0.05). Socio-demographic factors, such as age, and oral health conditions, such as discomfort in pronunciation or mastication due to oral problems, poor self-rated oral health, and reduced salivary flow, were associated with tongue, cheek, and lip muscle strengths (p < 0.05). Early active oral health interventions can help prevent a decline in orofacial muscle strength in healthy older adults. Full article

Background: The present study analyzed the relationship between oral motor and cognitive functions in community-dwelling older Korean adults. Methods: Study participants included 113 community-dwelling older adults with a mean age of 73.84 years. Subjects’ cognition was assessed using the Korean version of the Montreal Cognitive Assessment, and tongue, cheek, and lip pressures were assessed using the Iowa Oral Performance Instrument. Tongue and masseter thicknesses were measured using an ultrasound device (Sonon, Healcerion, Roseville, CA, USA). The occlusal force was measured using a specialized device (Innobyte, Kube Innovation, Montreal, QC, Canada), and the number of lost teeth was directly verified by a dental hygienist. Results: Results of analysis of cognitive function according to demographic characteristics of older community-dwelling adults revealed a significant difference in cognitive function according to education level and employment status. Cognitive function demonstrated a positive correlation with oral motor function, including pressure on the cheek, lips, and tongue, thickness of the masseter and tongue, occlusal force, number of lost teeth, and age. Hierarchical regression analysis revealed that demographic characteristics and cheek, lip, tongue, and masseter functions did not affect cognition, whereas occlusal force and number of lost teeth significantly affected cognition. In this study, oral motor function, excluding occlusal force and number of lost teeth, did not affect cognition. Conclusions: Future studies, however, are required to analyze the relationship between oral motor function and cognition in older adults with a wider range of such functions. Full article

The anatomy of the upper airways influences the risk of obstructive sleep apnea (OSA). The size of soft tissue structures, such as the tongue, soft palate, and lateral walls of the pharynx, contributes to the pathogenesis of OSA. New lines of treatment for sleep apnea, such as myofunctional therapy (MT), aim to strengthen the oropharyngeal musculature to improve the defining parameters of apnea. The present protocol uses ultrasound imaging to measure the size of the lingual musculature non-invasively and cost-effectively and evaluates the changes in its morphology. Eligible patients include those with OSA who have undergone submental cervical ultrasound and drug-induced sleep endoscopy before starting MT with the AirwayGym app. Follow-up evaluations are conducted at 3 months after beginning treatment. Patients diagnosed with OSA via questionnaires and polysomnography or respiratory polygraphy are evaluated anatomically and functionally using the Iowa Oral Performance Instrument, a tongue digital spoon, somnoscopy, and submental cervical ultrasound to assess their responses to the AirwayGym app. The lingual thickness (mm) and volume (cm³) and the distance between both lingual arteries (mm) are measured. The AirwayGym app helps users and therapists monitor the patient performance of MT. Incorporating submental ultrasound can be a useful non-invasive tool to evaluate OSA and MT. Full article

Most previous studies addressing dysphagia examined individuals who already had diseases causing dysphagia and did not pay much attention to oral health conditions as a risk factor. This pilot study investigated 62 healthy adults aged 65 years or older who were living independently in the community, performed basic activities of daily living independently, and had no history of a causative disease of dysphagia to identify the factors associated with dysphagia risk, especially oral health. The Dysphagia Risk Assessment Scale was used to screen the patients for dysphagia. Hyposalivation was diagnosed by evaluating the unstimulated salivary flow rate, and orofacial muscle strength (anterior tongue elevation, buccinator muscle, and lip strength) was quantitatively measured using the Iowa Oral Performance Instrument. To analyze the factors associated with dysphagia risk, the Mann–Whitney test, Kruskal–Wallis test, and multiple logistic regression analyses were conducted. In the final regression model adjusted for sociodemographic characteristics, the oral health-related factors independently associated with dysphagia risk were buccinator muscle strength, hyposalivation, and subjective masticatory discomfort (p < 0.05). Therefore, our findings suggest that weak buccinator muscle strength, hyposalivation, and subjective masticatory discomfort are valuable indicators for the early detection of dysphagia in older, healthy, independent, community-dwelling adults. Full article

Background: Perioral muscle function, which influences maxillofacial growth and tooth position, can be affected in patients with oral clefts due to their inherent anatomical characteristics and the multiple surgical corrections performed. This research aims to (1) compare the maximum oral muscle pressure of subjects with and without isolated cleft palate (CP) or unilateral cleft lip and palate (UCLP), (2) investigate its influence on their dentoalveolar characteristics, and (3) investigate the influence of functional habits on the maximum oral muscle pressure in patients with and without cleft. Material and methods: Subjects with and without CP and UCLP seeking treatment at the Department of Orthodontics of University Hospitals Leuven between January 2021 and August 2022 were invited to participate. The Iowa Oral Performance Instrument (IOPI) was used to measure their maximum tongue, lip, and cheek pressure. An imbalance score was calculated to express the relationship between tongue and lip pressure. Upper and lower intercanine (ICD) and intermolar distance (IMD) were measured on 3D digital dental casts, and the presence of functional habits was reported by the patients. The data were analyzed with multivariable linear models, correcting for age and gender. Results: 44 subjects with CP or UCLP (mean age: 12.00 years) and 104 non-affected patients (mean age: 11.13 years) were included. No significant differences in maximum oral muscle pressure or imbalance score were detected between controls and clefts or between cleft types. Significantly smaller upper ICDs and larger upper and lower IMDs were found in patients with clefts. A significant difference between controls and clefts was found in the relationship between oral muscle pressure and transversal jaw width. In cleft patients, the higher the maximum tongue pressure, the wider the upper and lower IMD, the higher the lip pressure, the smaller the upper and lower ICD and IMD, and the higher the imbalance score, the larger the upper and lower IMD and lower ICD. An imbalance favoring the tongue was found in cleft patients. The influence of functional habits on the maximum oral muscle pressure was not statistically different between clefts and controls. Conclusion: Patients with CP or UCLP did not present reduced maximum oral muscle pressure compared with patients without a cleft. In cleft patients, tongue pressure was consistently greater than lip pressure, and those who presented a larger maxillary width presented systematically higher imbalance scores (favoring the tongue) than those with narrow maxillae. Therefore, the influence of slow maxillary expansion on maximum oral muscle pressure in cleft patients should not be underestimated. Full article

Ankyloglossia (tongue-tie) is a condition of the oral cavity in which an abnormally short lingual frenulum affects the tongue’s mobility. Literature on the correlation between ankyloglossia and obstructive sleep apnea (OSA) is scarce. The main objective of this study was to report our preliminary experience in adult OSA patients before and after ankyloglossia treatment, using drug-induced sleep endoscopy (DISE) to evaluate the upper airway modifications resulting after treatment, and to present a systematic review of the impact of ankyloglossia and its treatment on OSA adults. We found that, after frenotomy, regarding the DISE findings, and according to the VOTE classification, two of the three patients showed an improvement in tongue level, from 2A-P (complete anteroposterior collapse) to 1ap (partial anteroposterior collapse). The third patient showed no changes in his UA after frenotomy, neither worsening nor showing improvement. Thus, the results of this study suggest that frenotomy in OSA patients with ankyloglossia could reduce tongue collapse, probably by allowing the tongue to take into the physiological position in the oral cavity. These patients should undergo speech therapy and oropharyngeal exercises prior to any surgical procedure, in order to avoid glossoptosis and to improve the quality of life and sleep apnea results. Full article

Myofunctional therapy (MT) is a recent treatment option for obstructive sleep apnea (OSA). The Iowa Oral Performance Instrument (IOPI) is a useful but expensive tool for measuring tongue strength in patients with OSA. We validated the Tongue Digital Spoon (TDS) to monitor tongue hypotonia in patients with OSA. Measurements with the IOPI and TDS were compared in patients with OSA before and after MT for tongue hypotonia. Baseline mean tongue strength measured with the IOPI in patients with moderate and severe OSA were 35.36 ± 9.05 and 33.83 ± 12.05, respectively, and that with the TDS were 168.55 ± 42.8 and 129.61 ± 53.7, respectively. After MT, mean tongue strength significantly improved: measured with the IOPI in patients with moderate and severe OSA were 53.85 ± 10.09 and 55.50 ± 9.64 (p = 0.8), and that with the TDS were 402.36 ± 52.92 and 380.28 ± 100.75 (p = 0.01), respectively. The correlation between the IOPI and TDS was high (r = 0.74; p = 0.01 pre-treatment, and r = 0.25; p = 0.05 post-treatment). The TDS is a useful tool for monitoring the efficacy of MT in patients with short-term OSA. Future randomized studies will determine the effectiveness of MT for the treatment of OSA. Full article

Swallowing is a complex but stereotyped motor activity aimed at serving two vital purposes: alimentary function and the protection of upper airways. Therefore, any impairment of the swallowing act can represent a significant clinical and personal problem that needs an accurate diagnosis by means of reliable and non-invasive techniques. Thus, a systematic review and meta-analysis was performed to investigate the reliability of the Iowa Oral Pressure Instrument (IOPI) in distinguishing healthy controls (HC) from patients affected by swallowing disorders or pathologies and conditions that imply dysphagia. A comprehensive search was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and using PubMed, Scopus, Web of Science, Cochrane, and Lilacs databases. Overall, 271 articles were identified and, after a three-step screening, 33 case-control and interventional studies reporting IOPI measurements were included. The methodological quality of the retrieved studies resulted in being at a low risk of bias. The meta-analysis on case-control studies showed that maximum tongue pressure (MIP) values were always higher in HC than in patients, with an overall effect of the MIP difference of 18.2 KPa (17.7–18.7 KPa CI). This result was also confirmed when the sample was split into adults and children, although the MIP difference between HC and patients was greater in children than in adults (21.0 vs. 15.4 KPa in the MIP mean difference overall effect, respectively). Tongue endurance (TE) showed conflicting results among studies, with an overall effect among studies near zero (0.7 s, 0.2–1.1 s CI) and a slight tendency toward higher TE values in HC than in patients. Among the intervention studies, MIP values were higher after treatment than before, with a better outcome after the experimental tongue training exercise than traditional treatments (the MIP mean difference overall effect was 10.8 and 2.3 KPa, respectively). In conclusion, MIP values can be considered as a reliable measure of swallowing function in adults and in children, with a more marked MIP difference between HC and patients for the children population. MIP measures in patients are also able to detect the best outcome on the tongue function after the training exercise compared to traditional training. Full article

Myofunctional therapy (MT) is used to treat sleep-disordered breathing. However, MT has low adherence—only ~10% in most studies. We describe our experiences with MT delivered through a mobile health app named Airway Gym^®, which is used by patients who have rejected continuous positive airway pressure and other therapies. We compared ear, nose, and throat examination findings, Friedman stage, tongue-tie presence, tongue strength measured using the Iowa oral performance instrument (IOPI), and full polysomnography before and after the 3 months of therapy. Participants were taught how to perform the exercises using the app at the start. Telemedicine allowed physicians to record adherence to and accuracy of the exercise performance. Fifty-four patients were enrolled; 35 (64.8%) were adherent and performed exercises for 15 min/day on five days/week. We found significant changes (p < 0.05) in the apnoea–hypopnoea index (AHI; 32.97 ± 1.8 to 21.9 ± 14.5 events/h); IOPI score (44.4 ± 11.08 to 49.66 ± 10.2); and minimum O₂ saturation (80.91% ± 6.1% to 85.09% ± 5.3%). IOPI scores correlated significantly with AHI after the therapy (Pearson r = 0.4; p = 0.01). The 19 patients who did not adhere to the protocol showed no changes. MT based on telemedicine had good adherence, and its effect on AHI correlated with IOPI and improvement in tongue-tie. Full article