J A Logemann

Northwestern University, Evanston, Illinois, United States

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Publications (124)358.06 Total impact

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    ABSTRACT: Background: Intensity-modulated radiotherapy (IMRT) is hoped to protect structures important for swallow function. We compared post-treatment swallow function in 7 pairs of head and neck cancer patients treated with either IMRT or conventional radiotherapy. Methods: Patients were matched on tumor characteristics. Swallowing function was evaluated with the modified barium swallow (MBS) procedure pretreatment and at 3 and 6 months post-cancer treatment completion. Swallows were analyzed for bolus transit times, bolus residues, laryngeal closure duration (LAC), cricopharyngeal opening duration (CPO), and oropharyngeal swallow efficiency (OPSE). Data were analyzed using multi-factor repeated measures analysis of variance and adjusted for baseline function. Results: Main effect of radiation type was significant for all measures on at least one bolus type. Patients treated with IMRT demonstrated shorter bolus transit times, less oral and pharyngeal residue, longer LAC, and larger OPSE. Conclusions: Patients treated with IMRT demonstrated faster, more efficient swallows, and greater airway protection. Head Neck, 2014.
    Head & Neck 08/2014; DOI:10.1002/hed.23796 · 3.01 Impact Factor
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    ABSTRACT: Background: No objective data are available to assess the potential damage induction chemotherapy alone contributes to swallowing physiology and salivary production in patients with locally and regionally confined head and neck cancer. Methods: Thirteen patients with head and neck cancer were evaluated pre- and post-induction chemotherapy. Assessment included 1) percent nutrition taken orally and food consistencies in diet; 2) videofluorographic swallow evaluation; 3) whole mouth saliva collection; 4) quality-of-life questionnaire; 5) pain and oral mucositis scores. Results: All patients were able to consume most foods and took 100% of their nutrition orally both pre- and post-induction chemotherapy. While a number of swallow measures worsened, no statistically significant differences were observed in diet, quality of life measures, pain, or saliva weight, or in most temporal swallow measures. Pharyngeal residue decreased significantly following chemotherapy. Conclusions: Induction chemotherapy alone did not significantly negatively alter swallowing physiology and salivary secretion although the trend was toward worsening in function. Head Neck, 2014.
    Head & Neck 04/2014; 37(4). DOI:10.1002/hed.23635 · 3.01 Impact Factor
  • Jerilyn A. Logemann
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    ABSTRACT: Normal oropharyngeal swallowing is a complex set of neuromotor behaviors containing three phases: (1) oral preparation to break food down to a swallowable consistency; (2) oral phase, which propels food from the mouth; (3) pharyngeal phase creates pressure to push food into the esophagus, and includes valve functions, which prevent food from entering the nose or airway and allow food into the esophagus. Systematic changes in normal oropharyngeal swallow are based on volume, viscosity, temperature and food textures/taste of the food swallowed as well as age. Patients with oropharyngeal swallowing difficulties (dysphagia) react differently to these systematic variables in food characteristics. This review manuscript presents the results of a series of studies that examine the role of each of the stages of the oropharyngeal swallow. The importance of the definition of food viscosity in the care of dysphagic patients and the role of food production companies in this effort are emphasized. Practical ApplicationsThe body of research work that we are summarizing and reviewing here is designed to provide a baseline regarding normal oropharyngeal swallow function in adults against which abnormalities in swallow can be compared. Understanding swallow disorders in the oral and pharyngeal stages of oropharyngeal deglutition enables food scientists to develop food textures, which are most successfully swallowable by specific types of dysphagic patients. All of the studies reviewed here have been approved by the Northwestern University Institutional Review Board.
    Journal of Texture Studies 04/2014; 45(3). DOI:10.1111/jtxs.12053 · 1.68 Impact Factor
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    ABSTRACT: BACKGROUND: Treatment for head and neck cancer can reduce peripheral sensory input and impair oropharyngeal swallow. This study examined the effect of enhanced bolus flavor on liquid swallows in these patients. METHODS: Fifty-one patients treated for head and neck cancer with chemoradiation or surgery and 64 healthy adult control subjects served as subjects. All were randomized to receive sour, sweet, or salty bolus flavor. Patients were evaluated at 7-10 days, 1 month, and 3 months after completion of tumor treatment. Control subjects received 1 assessment. RESULTS: All bolus flavors affected oropharyngeal swallow; sour flavor significantly shortened pharyngeal transit time across all evaluations. CONCLUSIONS: Sour flavor influenced the swallow of patients treated for head and neck cancer, as well as that of control subjects in a manner similar to those with neurologic impairment observed in an earlier study. Sour flavor may improve the speed of pharyngeal transit regardless of whether a patient has suffered peripheral or central sensory damage. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
    Head & Neck 08/2013; 35(8). DOI:10.1002/hed.23086 · 3.01 Impact Factor
  • Noga Nativ-Zeltzer, Peter J Kahrilas, Jerilyn A Logemann
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    ABSTRACT: Manofluorography, that is, the concurrent use of manometry and videofluorography for the evaluation of pharyngeal dysphagia, has not been widely used clinically, partially because of various limitations of conventional manometry. Technological advancements in recent years have led to substantial improvements in manometric devises, which can now overcome many of the shortcomings of standard manometry. In parallel with this, studies examining the utility of high-resolution manometry for the evaluation of pharyngeal disorders of swallowing have begun to emerge. This review summarizes the technological developments in manometry and the existing literature on pharyngeal high-resolution manofluorography with pressure topography. The article also discusses the potential clinical value of high-resolution pharyngeal-esophageal pressure topography and suggests directions for future investigations. Studies conducted so far have shown heterogeneous approaches to utilizing high-resolution manofluorography. These studies have revealed important information regarding its diagnostic potential and researchers have devised innovative methods of measurements. However, substantial research is required to transform manofluorography into a clinically useful tool. There is a need to conduct validation studies, correlating manometric measures with structural changes in the swallow seen on videofluorography and devise diagnostic methods that utilize the advantages of both tools. Furthermore, studies comparing healthy and clinical populations are needed to identify measures most clinically significant in order to develop diagnostic paradigms.
    Dysphagia 04/2012; 27(2):151-61. DOI:10.1007/s00455-012-9405-1 · 1.60 Impact Factor
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    ABSTRACT: Acute oral mucositis is associated with pain and impaired swallowing. Little information is available on the effects of chronic mucositis on swallowing. Sixty patients treated for cancer of the head and neck were examined during the first year after their cancer treatment. Oral mucosa was rated with the Oral Mucositis Assessment Scale. Stimulated whole-mouth saliva, oral pain rating, percent of oral intake, and 2 subscales of the Performance Status Scale for Head and Neck (PSS-HN) cancer were also collected. Mucositis scores and pain ratings decreased over time while functional measures of eating improved over time. Reduction in chronic mucositis was correlated with improved oral intake and diet. Lack of association with pain was attributed to the absence of ulcerations. Continued impairment of oral intake during the first year posttreatment may be related to oral mucosal changes and other factors.
    Head & Neck 06/2011; 33(6):774-9. DOI:10.1002/hed.21542 · 3.01 Impact Factor
  • J A Logemann, K Larsen
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    ABSTRACT: The oropharyngeal swallow involves a rapid, highly coordinated set of neuromuscular actions beginning with lip closure and terminating with opening of the upper esophageal sphincter. Evaluation of the oropharyngeal swallow usually involves the use of a modified barium swallow radiographic study with the goals of (i) defining the patient's swallow anatomy and physiology causing the dysphagia; and (ii) evaluating the immediate effectiveness of treatment procedures including selected postures, sensory enhancement, swallow maneuvers, and diet changes. Exercise programs may be helpful, but their immediate effects cannot be examined during the initial modified barium swallow. Exercise programs can be evaluated on a second radiographic study 3-4 weeks later. The resultant report should include all of this information. The speech-language pathologist is usually the professional most involved in the evaluation and treatment. Medications and surgery have a very limited role in the treatment of oropharyngeal dysphagia.
    Diseases of the Esophagus 05/2011; 25(4):299-304. DOI:10.1111/j.1442-2050.2011.01210.x · 2.06 Impact Factor
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    ABSTRACT: A Histogram Analysis in Radiation Therapy (HART) program was primarily developed to increase the efficiency and accuracy of dose-volume histogram (DVH) analysis of large quantities of patient data in radiation therapy research. The program was written in MATLAB to analyze patient plans exported from the treatment planning system (Pinnacle 3 ) in the American Association of Physicists in Medicine/Radiation Therapy Oncology Group (AAPM/RTOG) format. HART-computed DVH data was validated against manually extracted data from the planning system for five head and neck cancer patients treated with the intensity-modulated radiation therapy (IMRT) technique. HART calculated over 4000 parameters from the differential DVH (dDVH) curves for each patient in approximately 10-15 minutes. Manual extraction of this amount of data required 5 to 6 hours. The normalized root mean square deviation (NRMSD) for the HART-extracted DVH outcomes was less than 1%, or within 0.5% distance-to-agreement (DTA). This tool is supported with various user-friendly options and graphical displays. Additional features include optimal polynomial modeling of DVH curves for organs, treatment plan indices (TPI) evaluation, plan-specific outcome analysis (POA), and spatial DVH (zDVH) and dose surface histogram (DSH) analyses, respectively. HART is freely available to the radiation oncology community.
    Journal of Applied Clinical Medical Physics 01/2010; 11(1):3013. · 1.11 Impact Factor
  • Fuel and Energy Abstracts 11/2009; 75(3). DOI:10.1016/j.ijrobp.2009.07.991
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    ABSTRACT: Pharyngeal manometry complements the modified barium swallow with videofluoroscopy (VFS) in diagnosing pressure-related causes of dysphagia. When manometric analysis is not feasible, it would be ideal if pressure information about the swallow could be inferred accurately from the VFS evaluation. Swallowing function was examined using VFS and concurrent manometry in 18 subjects (11 head and neck patients treated with various modalities and 7 healthy adults). Nonparametric univariate and multivariate analyses revealed significant relationships between manometric and fluoroscopic variables. Increases in pressure wave amplitude were significantly correlated with increased duration of tongue base to pharyngeal wall contact, reduced bolus transit times, and oropharyngeal residue. Pharyngeal residue was the most important VFS variable in reflecting pharyngeal pressure measurements. Certain VFS measures were significantly correlated with measures of pressure assessed with manometry. Further research is needed before observations and measures from VFS alone may be deemed sufficient for determining pressure-generation difficulties during the swallow in patients who are unable or unwilling to submit to manometric testing.
    Dysphagia 06/2009; 24(2):196-203. DOI:10.1007/s00455-008-9192-x · 1.60 Impact Factor
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    ABSTRACT: Postoperative speech function may be influenced by a number of treatment variables. The objective of this study was to examine the relationships among various treatment factors to determine the impact of these measures on speech function. Speech function was tested prospectively in 142 patients with surgically treated oral and oropharyngeal cancer 3 months after treatment. Each patient's speech was recorded during a 6- to 7-minute conversation and while performing a standard articulation test, producing speech outcome measures of percent correct consonant phonemes and percent conversational understandability. Correlational analyses were used to determine the relationships among the speech outcome measures and 14 treatment parameters. Speech function was mildly to moderately negatively correlated with most surgical resection variables, indicating that larger amounts of tissue resected were associated with worse speech function. Overall measures of conversational understandability and percent correct consonant phonemes were related to extent of oral tongue resection, floor of mouth resection, soft palate resection, and total volume of tissue resected. These relationships varied depending on the method of surgical closure. Method of surgical reconstruction had a profound impact on postoperative speech function 3 months after treatment and was an important factor in determining how oral tongue resection influenced articulation and intelligibility. The combination of closure type, percent oral tongue resected, and percent soft palate resected had the strongest relationship with overall speech function for patients with surgically treated oral and oropharyngeal cancer 3 months after treatment.
    The Laryngoscope 01/2009; 108(6):908 - 916. DOI:10.1097/00005537-199806000-00022 · 2.03 Impact Factor
  • Medical Physics 01/2009; 36(6). DOI:10.1118/1.3181592 · 3.01 Impact Factor
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    ABSTRACT: Earlier studies of the effect of 6 weeks of the Shaker Exercise have shown significant increase in UES opening and anterior excursion of larynx and hyoid during swallowing in patients with upper esophageal sphincter (UES) dysfunction, resulting in elimination of aspiration and resumption of oral intake. This effect is attributed to strengthening of the suprahyoid muscles, as evidenced by comparison of electromyographic changes in muscle fatigue before and after completion of the exercise regime. The effect of this exercise on thyrohyoid muscle shortening is unknown. Therefore the aim of this study was to determine the effect of the exercise on thyrohyoid muscle shortening. We studied 11 dysphagic patients with UES dysfunction. Six were randomized to traditional swallowing therapy and five to the Shaker Exercise. Videofluoroscopy was used to measure deglutitive thyrohyoid shortening before and after completion of assigned therapy regimen. Maximum thyrohyoid muscle shortening occurred at close temporal proximity to the time of maximal thyroid cartilage excursion. The percent change in thyrohyoid distance from initiation of deglutition to maximal anterior/superior hyoid excursion showed no statistically significant difference between the two groups prior to either therapy (p = 0.54). In contrast, after completion of therapy, the percent change in thyrohyoid distance in the Shaker Exercise group was significantly greater compared to the traditional therapy (p = 0.034). The Shaker Exercise augments the thyrohyoid muscle shortening in addition to strengthening the suprahyoid muscles. The combination of increased thyrohyoid shortening and suprahyoid strengthening contributes to the Shaker Exercise outcome of deglutitive UES opening augmentation.
    Dysphagia 09/2008; 24(1):26-31. DOI:10.1007/s00455-008-9167-y · 1.60 Impact Factor
  • Radiotherapy and Oncology 02/2007; 69(3). DOI:10.1016/j.ijrobp.2007.07.1663 · 4.86 Impact Factor
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    ABSTRACT: Background.Current research demonstrates that swallow function is impaired after treatment with organ-sparing chemoradiotherapy. Few studies, however, have related observed swallowing disorders with the patient's oral intake and diet in a large cohort of patients.Methods.Swallowing function was examined using the modified barium swallow (MBS) procedure in 170 patients treated with radiotherapy with or without chemotherapy for cancer of the head and neck at 5 evaluation points: pretreatment and at 1, 3, 6, and 12 months posttreatment. Fisher's exact test was used to examine the relationship between swallow motility disorders and oral intake or diet consistencies.Results.Limitations in oral intake and diet during the first year after cancer treatment were significantly related to reduced laryngeal elevation, reduced cricopharyngeal opening, and rating of nonfunctional swallow on at least 1 swallow of any bolus type.Conclusions.Swallow motility disorders had a significant impact on the eating ability of patients after treatment for head and neck cancer with radiotherapy with or without chemotherapy. © 2006 Wiley Periodicals, Inc. Head Neck, 2006
    Head & Neck 12/2006; 28(12):1069 - 1076. DOI:10.1002/hed.20459 · 3.01 Impact Factor
  • Article: R194
    Susan E. Langmore, Jerilyn A. Logemann, Cathy Lazarus
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    ABSTRACT: Fourteen participants (six females, eight males) ranging in age from 7 years 11 months to 18 years 2 months (mean 11y 7mo) with a confirmed diagnosis of spastic cerebral palsy (CP) were included in the study. Participants included those who drooled (CP+, n=14); age- and sex-matched children with spastic CP who were dry to mild and never to infrequent droolers (CP-, n=14) as well as typically developing peers (CTRL, n=14) served as controls. Frequency of swallowing was measured by using simultaneous cervical ausculation and videotaping of the head and neck. Saliva production was measured with the Saxon test, a simple gauze-chewing procedure. In addition, Pediatric Evaluation of Disability Inventory (PEDI), Test of Nonverbal Intelligence-3 (TONI-3), dysarthria severity scale, and Gross Motor Function Classification System (GMFCS) scores were obtained for each participant. Both groups of participants with CP tended to swallow less frequently than typically developing participants and tended to produce less saliva than typically developing controls; however, these differences were not statistically significant. No correlation was found between amount of saliva produced and amount drooled (r=0.245). An analysis of variance (ANOVA) conducted on the PEDI functional skills mean scores indicated significant differences between the three groups (F(2,39)=23.522,p<0.0001). Likewise, an ANOVA conducted on the TONI-3 scores revealed statistically significant differences between the three groups (F(2,39)=31.761, p<0.0001). A Spearman's rho correlation indicated that GMFCS scores were not significantly correlated with drooling severity (Spearman's rho correlation=0.3951,p=0.037). Drooling severity was found to be positively correlated with dysarthria severity (Spearman's rho correlation=0.82,p<0.0001). These findings suggest that drooling in patients with CP is related to swallowing difficulties rather than hypersalivation.
    Developmental Medicine & Child Neurology 01/2005; 46(12):801-6. DOI:10.1017/S0012162204001409 · 3.29 Impact Factor
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    ABSTRACT: Background.Postoperative swallowing function may be influenced by a number of treatment variables; this study examines the relationship of various treatment factors to measures of swallow function.Methods.Swallowing was examined with the modified barium swallow procedure in 144 patients surgically treated for oral or oropharyngeal cancer 3 months after healing. Univariate and multivariate correlations were used to examine the relationship between swallowing function and treatment.Results.Percent tongue base resected and total volume resected were most often correlated with swallowing function in the univariate analyses. Multivariate analyses identified the following combinations with the strongest correlations: (1) percent tongue base resected and closure type for liquids; (2) percent tongue base resected and unreconstructed mandible for pastes; (3) total volume resected, percent lateral floor of mouth resected, and postoperative radiotherapy dose for masticated boluses.Conclusions.Total volume resected and percent tongue base resected had a profound impact on postoperative swallowing function. Combinations of percent tongue base resected with other surgical variables had the strongest relationships with overall swallowing function. © 2004 Wiley Periodicals, Inc. Head Neck26: 625–636, 2004
    Head & Neck 07/2004; 26(7):625 - 636. DOI:10.1002/hed.20013 · 3.01 Impact Factor
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    ABSTRACT: Treatment decisions in head and neck cancer (HNC) might involve consideration of uncertain tradeoffs of one late effect against another or increasing toxicity or residual impairment for increased chance of survival. Understanding how patients prioritize potential outcomes, as well as whether these preferences are similar to those of nonpatients, is important to informed decision making and treatment planning. Two hundred forty-seven newly diagnosed HNC patients from nine institutions and 131 nonpatients rank ordered a set of 12 potential treatment outcomes (eg, cure; being able to swallow; normal voice) from highest (1) to lowest (12). Patients and nonpatients were similar with respect to the three items most frequently ranked in the top three, that is, "being cured of cancer," "living as long as possible," and "having no pain" in that order. In contrast, patients more frequently ranked "cure" (90% vs 80%) and less frequently ranked "no pain" (34% vs 52%) in the top three. Survival seems to be of paramount importance to both patient and nonpatient groups, overshadowing associated toxicities and potential dysfunction. At the same time, patients might be more willing than nonpatients to undergo aggressive treatments and endure acute distress in the interest of potential long-term gains (ie, cure or longer survival).
    Head & Neck 02/2004; 26(2):163-70. DOI:10.1002/hed.10367 · 3.01 Impact Factor
  • International Journal of Radiation OncologyBiologyPhysics 01/2004; 57(5):1219-30. DOI:10.1016/S0360-3016(03)01454-8 · 4.18 Impact Factor

Publication Stats

5k Citations
358.06 Total Impact Points


  • 1986–2014
    • Northwestern University
      • • Department of Preventive Medicine
      • • Department of Medicine
      • • Department of Otolaryngology - Head and Neck Surgery
      Evanston, Illinois, United States
  • 2009
    • Northwestern Memorial Hospital
      Chicago, Illinois, United States
  • 2004
    • University of Chicago
      • Department of Medicine
      Chicago, Illinois, United States
  • 1992
    • University of Illinois at Chicago
      Chicago, Illinois, United States
  • 1988
    • Emory University
      • Department of Surgery
      Atlanta, Georgia, United States