Speech–language pathologists at NYU Langone’s Rusk Rehabilitation conduct translational research to advance the evaluation and treatment of dysphagia in patients.

Matina Balou, PhD, CCC-SLP, BCS-S, is a clinically trained speech–language pathologist whose clinical practice and research activities focus on understanding, preventing, and treating swallowing disorders or dysphagia. Dr. Balou’s productive research program is diverse. Broadly, she seeks to develop treatment paradigms to improve upper airway dysfunction and swallow efficiency in patients with head and neck cancer and patients with spinal cord injuries. Her research uses high-resolution manometry and videofluoroscopy to understand the pressure foundations of swallowing components in the normal population and patients with dysphagia.

Clinical Studies on Dysphagia

Dr. Balou is currently examining the prevalence of self-reported dysphasia after anterior cervical discectomy and fusion. Up to 71 percent of people who have an anterior cervical discectomy and fusion procedure experience swallowing impairment related to postsurgical edema, iatrogenic injury, or both. Patients with dysphagia secondary to anterior cervical discectomy and fusion are underrecognized, underdiagnosed, and not proactively managed. Dr. Balou will expand this line of investigation to employ videofluoroscopy to quantify the disrupted biomechanics of swallowing in this population.

Dr. Balou also leads a study examining the prevalence of co-occurrence of upper esophageal sphincter and distal esophageal motility disorders based on the Chicago Classification of esophageal motility disorders. Dr. Balou’s research team employs high-resolution manometry to identify therapeutic targets for this challenging patient population.

Dr. Balou and her colleagues are also investigating a correlation between tongue strength and oropharyngeal swallow outcomes. Although a growing number of studies have proven the ability of therapy to increase peak lingual swallow pressures, Dr. Balou’s study is focusing on the connection between peak lingual swallow pressures and both the swallow efficiency and swallow safety findings from the videofluoroscopic swallowing study.

Dr. Balou is also investigating contributions of anterior cervical osteophytes to oropharyngeal dysphagia in older patients. Relatively few studies have examined the effect of anterior cervical osteophytes on the swallowing mechanism and the severity of dysphagia in the older adult population. The research team is investigating the relationship between both swallow efficiency and swallow safety and patient osteophyte findings from videofluoroscopic examinations.

Her team also analyzes videofluoroscopic swallowing studies, flexible endoscopic examination of swallowing procedure results, and static three-dimensional MRI images to categorize the epiglottis by phenotype. Dr. Balou’s team aims to create a classification system for the epiglottis at rest, at the peak of a patient swallowing, and after a patient swallows. Specifically, the team measures epiglottic tilt angle, area, and thickness and use the Normalized Residue Ratio Scale to capture swallowing efficiency using ImageJ, a Java-based image processing program developed at the National Institutes of Health and the Laboratory for Optical and Computational Instrumentation.

The epiglottis is a lamella of yellow cartilage that—in addition to the closure of the aryepiglottic folds, false vocal folds, and true vocal folds—protects the airway during swallowing. Research suggests that the styloglossus, hyoglossus, and long pharyngeal muscles are targets for rehabilitation in patients who have dysphagia because of impaired epiglottic inversion. Although epiglottic dysfunction has been associated with aspiration, a standardized classification scheme to characterize the tilt, shape, and thickness of the epiglottis does not currently exist.