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Expiratory muscle strength training ( EMST) involves forcible blowing as a means of generating high expiratory pressure, against adjustable resistance. EMST has recently been introduced as a potential treatment for dysphagia. This study was performed to investigate the effects of EMST on the activity of suprahyoid muscles, aspiration and dietary stages in stroke patients with dysphagia. Twenty-seven stroke patients with dysphagia were randomly divided into two groups. The experimental group performed EMST with a 70% threshold value of maximal expiratory pressure, using an EMST device, 5 days a week for 4 weeks. The placebo group trained with a sham device. The EMST regime involved 5 sets of 5 breaths through the EMST device for a total of 25 breaths per day. Activity in the suprahyoid muscle group was measured using surface electromyography ( sEMG). Further, the penetration-aspiration scale ( PAS) was used to assess the results of the videofluoroscopic swallowing study ( VFSS). In addition, dietary stages were evaluated using the Functional Oral Intake Scale ( FOIS). The experimental group exhibited improved suprahyoid muscle group activity and PAS results, when compared to the placebo group. Following intervention, statistical analysis indicated significant differences in measured suprahyoid muscle activity ( P = 0·01), liquid PAS outcomes ( P = 0·03) and FOIS results ( P = 0·06), but not semisolid type PAS outcomes ( P = 0·32), between the groups. This study confirms EMST as an effective treatment for the development of suprahyoid muscle activity in stroke patients with dysphagia. Additionally, improvements in aspiration and penetration outcomes were observed. [ABSTRACT FROM AUTHOR]

Objectives: Auditory neuropathy spectrum disorder (ANSD) is a disorder, in which the transmission of sound signal from the inner ear to the auditory nerve/ brain cortex is impaired, while the outer hair cells function normally. Previously, our group reported that anatomically intact, prelingual-onset, ANSD in Koreans is mainly due to mutations in OTOF (DFNB9). Since our previous report, we further recruited anatomically intact, prelingualonset ANSD subjects and we disclosed a mutational and phenotypic spectrum of OTOF-related ANSD in the Korean population. Materials and Methods: Six patients with ANSD were recruited from two referral hospitals. Genetic diagnosis was made through the screening panel, targeted exome sequencing, or whole exome sequencing. Together with five previously documented DFNB9 patients, a total of 11 patients' genotypic and phenotypic analysis was made. Results: Genetic diagnosis identified three novel variants of OTOF in our cohorts: a nonsense variant, p.Tyr1064Ter, a missense variant, p.Gly1845Glu, and a splice site variant, c.4227+5G>C. Regarding the contribution of each OTOF variants in Korean ANSD, p.Arg1939Gln was most commonly identified among the 22 alleles in 11 DFNB9 subjects, with its frequency in our cohort calculated to be 36.4%, followed by p.Glu841Lys (13.6%), p.Leu1011Pro (9.1%) and p.Arg1856Trp (9.1%). Although ABR results of our patients consistently did not show responses to sound, ASSR results demonstrated relatively diverse spectrum of hearing status including significant residual hearing and asymmetric hearing. Ten of 11 patients received cochlear implantation for auditory rehabilitation, showing favorable outcomes with more rapid improvement on early-CI group (age at CI ≤ 18 mo.) than late-CI group. Conclusions: Here, we report three novel variants of OTOF, related with ANSD and confirmed the significant contribution of a recurring predominant variant (p.Arg1939Gln) of OTOF to Korean ANSD in our cohorts which is, to date, the largest OTOF-related ANSD cohort in Korea. Additionally, relatively diverse auditory spectrum of DFNB9 was observed in the ASSR results of our patients. Clinically, given the genotypic spectrum of our cohorts, we suggest the four major alleles of OTOF: p.Arg1939Gln, p.Glu841Lys, p.Leu1011Pro and p.Arg1856Trp as included in a screening panel to facilitate the molecular genetic diagnosis of Korean OTOF-related ANSD, further prompting the early CI for timely development of auditory perceptive ability. [ABSTRACT FROM AUTHOR]