Quantitative approach to analyze hyoid bone movement during swallowing by ultrasound: an integrative review

Magalhães, Desiré Dominique Diniz de; Bandeira, Jayne de Freitas; Pernambuco, Leandro

doi:10.1590/2317-1782/20232022002en

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Systematic Review • CoDAS 35 (4) • 2023 • https://doi.org/10.1590/2317-1782/20232022002en copy

Quantitative approach to analyze hyoid bone movement during swallowing by ultrasound: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

To synthesize the scientific knowledge on which measurements of hyoid bone movement during swallowing are obtained by ultrasonography and how to extract these measures.

Research strategies

The PECO question and combinations of descriptors and keywords were formulated in the electronic databases Medline/PubMed, EMBASE, Web of Science, Scopus and Lilacs.

Selection criteria

Articles that used ultrasonography to analyze measurements of hyoid bone movement during swallowing were included, regardless of language, year of publication, or presence of deglutition disorders.

Data analysis

The included articles were analyzed for: year, study site, study design, population, sample size, equipment used, transducer positioning, measurements obtained, method of extraction, and reliability of measurements.

Results

Twenty-six articles met the eligibility criteria. The most frequent measurement was hyoid movement maximum amplitude, followed by time and velocity. There was great variability in the study population, equipment used, positioning of the transducer and method of extraction of the measurements. Thus, it was not possible to find a standard model to extract the measures. The level of reliability was investigated in only eight articles.

Conclusion

Amplitude, time and velocity are the measures of hyoid bone movement during swallowing that can be obtained by ultrasonography. There is no standardization on how to extract these measurements.

Keywords:
Deglutition; Deglutition Disorders; Ultrasonography; Hyoid Bone; Movement

Author, year and place of study	Population and sample size	Device used	Positioning of ultrasonography transducer	Measures of hyoid bone movement during deglutition	Method for extraction of measures	Reliability of measures
Chen et al.⁽²⁶26 Chen YC, Chen PY, Wang YC, Wang TG, Han DS. Decreased swallowing function in the sarcopenic elderly without clinical dysphagia: a cross-sectional study. BMC Geriatr. 2020;20(1):419. http://dx.doi.org/10.1186/s12877-020-01832-0. PMid:33087067. http://dx.doi.org/10.1186/s12877-020-018... ⁾, 2020, Taiwan	98 seniors over 65 years old:	Unspecified	Submandibular area	Time = time interval from the beginning of the deglutition-related HB movement to the first moment of maximum amplitude in the course of the forward movement;	Unspecified	Not investigated
	47 with sarcopenia			Velocity = amplitude of the hyoid bone (HD) divided by the time interval.
	47 without sarcopenia
Chen et al.⁽²⁷27 Chen YC, Hsiao MY, Chen PY, Wang TG. Effects of age on the speed of hyoid bone movement during swallowing. Int J Gerontol. 2019;13:344-8.⁾, 2019, Taiwan	97 healthy adults without dysphagia	Self-designed model (LT701, LT701-000; LELTEK Corporation), connected to laptop, with curvilinear transducer (Convex Array, 3.75 MHz, P701-C04; LELTEK Corporation, Taipei City, Taiwan).	Submandibular area	Time interval from onset to amplitude	Using a two-axis coordinate system, the position of the HB relative to the mandible in each frame was represented as coordinate pairs. The distance between two coordinates before and during deglutition indicated the HB amplitude. The software employed was developed using the C Sharp programming language (Microsoft Visual Studio 2015; Microsoft, Redmond, WA, USA).	ICC = 0.845 (p <0.01)
				Amplitude
				Velocity
Chen et al.⁽¹²12 Chen YC, Hsiao MY, Wang YC, Fu CP, Wang TG. Reliability of ultrasonography in evaluating hyoid bone movement. J Med Ultrasound. 2017;25(2):90-5. http://dx.doi.org/10.1016/j.jmu.2017.01.002. PMid:30065466. http://dx.doi.org/10.1016/j.jmu.2017.01.... ⁾, 2017, Taiwan	10 patients:	Self-designed model (LT701, LT701-000; LELTEK Corporation), connected to laptop, with curvilinear transducer (Convex Array, 3.75 MHz, P701-C04; LELTEK Corporation, Taipei City, Taiwan).	Submandibular area	Amplitude	The superior anterior margin of the fourth cervical vertebral body was used as a reference point for calculating HB movement. The initial position of the HB was marked and the movement relative to the reference point was calculated frame by frame to determine the amplitude.	Intra-examiner ICC of the two examiners = 0.996 and 0.959 (p <0.01), respectively.
	▪ 1 with stroke					Inter-examiner ICC = 0.892 (p <0.05)
	▪ 1 with neuromuscular disease
	▪ 1 with traumatic brain injury
	▪ 1 with chronic obstructive pulmonary disease
	▪ 1 with spinal cord injury
	▪ 1 with aspiration pneumonia
	▪ 1 with gastroesophageal reflux disease
Chi-Fishman e Sonies⁽²⁸28 Chi-Fishman G, Sonies BC. Effects of systematic bolus viscosity and volume changes on Hyoid Movement Kinematics Gloria. Dysphagia. 2002;17(4):278-87. http://dx.doi.org/10.1007/s00455-002-0070-7. PMid:12355143. http://dx.doi.org/10.1007/s00455-002-007... ⁾, 2002, Estados Unidos	31 healthy adults:	Ultramark 9 model (Advanced Technology Laboratories; Bothell, WA) in combination with a Horita II time code generator (Mission Viejo, CA, model TRG-50PC) at 1/30-s speed, a Horita video distribution amplifier (VDA-50 Model) and a Sony U-matic VCR recorder (Tokyo, Japan, VO-5850 Model). 3.5-6.0 MHz wide openness annular array transducer.	Submandibular area	Duration of movement	Changes in position, such as points with cartesian X and Y coordinates, were measured. Each frame was a 640 × 480 matrix of pixels scaled to the centimeter unit at 39 pixels/centimeter based on the known depth. The reference point where X and Y were both equivalent to zero was in the upper left corner of each frame. All measurements were made with contrast enhancement using NIH Image version 1.61 with a custom macro.	Not investigated
	16 men			Amplitude/distance (where amplitude is the maximum movement achieved in the forward movement course only and distance is the total distance traveled in the forward and backward courses)
	15 women			Velocity
Chi-Fishman e Sonies⁽²⁹29 Chi-fishman G, Sonies BC. Kinematic strategies for hyoid movement in rapid sequential swallowing. J Speech Lang Hear Res. 2002 Jun;45(3):457-68. http://dx.doi.org/10.1044/1092-4388(2002/036). PMID: 12068999. http://dx.doi.org/10.1044/1092-4388(2002... ⁾, 2002, Estados Unidos	30 healthy people stratified into three groups (young, middle-aged and elderly):	Ultramark 9 model (Advanced Technology Laboratories; Bothell, WA) in combination with a Horita II time code generator (Mission Viejo, CA, model TRG-50PC) at 1/30-s speed, a Horita video distribution amplifier (VDA-50 Model) and a Sony U-matic VCR recorder (Tokyo, Japan, VO-5850 Model). 3.5-6.0 MHz wide openness annular array transducer.	Submandibular area	Maximum amplitude	Changes in position, such as points with cartesian X and Y coordinates, were measured frame by frame by visual identification of the intersection of the anterior edge of the acoustic shadow of the HB and the upper edge of the muscles. Each frame was a 640 × 480 matrix of pixels scaled to the centimeter unit at 39 pixels/centimeter based on the known depth. All measurements were made with contrast enhancement using NIH Image version 1.61 with a custom macro.
	15 men			Amplitude difference from start to finish
	15 women			Total distance
				Forward peak velocity
				Peak backward velocity
				Time from start to maximum
				Time on maximum
				Time from maximum to end
				Total time
				Time to peak velocity forward and backward
				Stiffness index
Costa et al.⁽¹⁴14 Costa BOI, Rodrigues DSB, de Magalhães DDD, Santos AS, Santos RV, Azevedo EHM, et al. Quantitative ultrasound assessment of hyoid bone displacement during swallowing following thyroidectomy. Dysphagia. 2020;36:659-69. http://dx.doi.org/10.1007/s00455-020-10180-5. PMid:32889628. http://dx.doi.org/10.1007/s00455-020-101... ⁾, 2020, Brasil	40 women	LOGIQ P6 Model (GE Healthcare ®, Chicago, IL) in B mode, Vascular> Carotid adjustment, frame/second rate, 2.0-5.5 MHz convex linear array transducer.	Larynx (anterior area)	Lifting time	The videos were initially decomposed into frames using the converter Free Video to JPG Converter and subsequently analyzed using the software ImageJ to extract the measures of interest. Each measurement was the result of the time between the initial frame and the final frame of the respective event, in seconds. Each frame had 0.03 s (30 frames/second), so the number of frames for each measurement was calculated.	Inter-examiners ICC = 0.5 to 0.71
	20 submitted to total/partial thyroidectomy			Anteriorization time		Intra-examiner ICC (best examiner) = 0.75 to 0.92
	20 healthy women			Maximum amplitude time
				Maximum amplitude holding time
Dejaeger e Pelemans⁽²⁵25 Dejaeger E, Pelemans W. Swallowing and the duration of the hyoid movement in normal adults of different ages. Aging (Milano). 1996;8(2):130-4. http://dx.doi.org/10.1007/BF03339567. PMid:8737612. http://dx.doi.org/10.1007/BF03339567... ⁾, 1996, Bélgica	120 healthy individuals	Toshiba Sonolayer-L Sal 77A Model with a transducer of 3.75 MHz and a rate of 30 frames/second.	Unspecified	Time	The time was measured from the frame in which the HB moved anteriorly and superiorly from a rest position to the frame in which it returned to a stable rest position.	Not investigated
Feng et al.⁽³⁰30 Feng X, Cartwright MS, Walker FO, Bargoil JH, Hu Y, Butler SG. Ultrasonographic evaluation of geniohyoid muscle and hyoid bone during swallowing in young adults. Laryngoscope. 2015;125(8):1886-91. http://dx.doi.org/10.1002/lary.25224. PMid:25739655. http://dx.doi.org/10.1002/lary.25224... ⁾, 2015, Estados Unidos	40 healthy young adults (20-40 years old):	Biosound MyLab25 Model (Esaote Group, Genoa, Italy), with an 18 MHz linear transducer.	Submandibular region	Maximum distance	Images of the movement from rest to maximum course were recorded and saved. The moving images have been revised and the frames have been frozen.	Not investigated
	20 men			Anterior amplitude
	20 women			Superior amplitude
Hsiao et al.⁽²⁰20 Hsiao MY, Chang YC, Chen WS, Chang HY, Wang TG. Application of Ultrasonography in Assessing Oropharyngeal Dysphagia in Stroke Patients. Ultrasound Med Biol. 2012;38(9):1522-8. http://dx.doi.org/10.1016/j.ultrasmedbio.2012.04.017. PMid:22698507. http://dx.doi.org/10.1016/j.ultrasmedbio... ⁾, 2012, Taiwan	60 patients with stroke	Self-designed model with a curvilinear transducer (BS3C673 Convex Array, 3.5 MHz, BSUS20-32C; Broadsound Corporation, Taiwan). Rate of 22.5 frames/second.	Submandibular area	Amplitude	The mandible was used as a reference point for calculating the movement of the HB. Using a two-axis coordinate system, the position of the HB relative to the mandible in each frame was represented as coordinate pairs. The distance between two coordinates before and during deglutition indicated the HB amplitude. The software used in this study was developed in MATLAB (v. 7.5.0, R2007b; The MathWorks, Inc., Boston, MA). The measurements were repeated 3 times for each participant to obtain the mean values for statistical analysis.	Intra-examiner ICC of the two examiners = 0.927 and 0.842, respectively;
	40 healthy individuals		Submandibular area	Amplitude		Inter-examiner ICC = 0.806.
Kwak et al.⁽⁵5 Kwak HJ, Kim L, Ryu BJ, Kim YH, Park SW, Cho DG, et al. Influence of nasogastric tubes on swallowing in stroke patients: measuring hyoid bone movement with ultrasonography. Ann Rehabil Med. 2018;42(4):551-9. http://dx.doi.org/10.5535/arm.2018.42.4.551. PMid:30180524. http://dx.doi.org/10.5535/arm.2018.42.4.... ⁾, 2018, Korea	20 patients with stroke and nasoenteral probe	Accuvix V10 model (Medison, Seoul, Korea) with a 3-6 MHz curved array transducer	Submandibular area	Time	Using the Kinovea v. 0.8.15 software, the time was automatically measured in milliseconds after the marker was placed on the HB. The area drawn by the marker is measured in pixel units using ImageJ 1.51 p. The analysis of the maximum movement is done by finding the greatest amplitude between any two points of the HB course during deglutition.	Not investigated
	25 patients with stroke and without nasoenteral probe			Amplitude
	25 healthy adults without brain injury or dysphagia
Lee et al.⁽³¹31 Lee YS, Lee KE, Kang Y, Yi TI, Kim JS. Usefulness of submental ultrasonographic evaluation for dysphagia patients. Ann Rehabil Med. 2016;40(2):197-205. http://dx.doi.org/10.5535/arm.2016.40.2.197. PMid:27152268. http://dx.doi.org/10.5535/arm.2016.40.2.... ⁾, 2016, Korea	21 adults who did not inhale	LOGIQ E9 model (GE Healthcare, Milwaukee, WI, USA) with a 1-5 MHz curved probe.	Submandibular area	Amplitude	The examination was performed by measuring the distance between the acoustic shadows of the mandible and the HB at rest and during deglutition. The difference in distance was defined as amplitude of the HB. The HB amplitude's percentage was defined by the delta value.	Not investigated
	20 adults who had penetration
	11 adults who inhale
Li et al.⁽⁴³43 Li CM, Wang TG, Lee HY, Wang HP, Hsieh SH, Chou M, et al. Swallowing training combined with game-based biofeedback in poststroke dysphagia. PM R. 2016;8(8):773-9. http://dx.doi.org/10.1016/j.pmrj.2016.01.003. http://dx.doi.org/10.1016/j.pmrj.2016.01... ⁾, 2016, Taiwan	20 individuals with post-stroke dysphagia:	Self-designed model with a curvilinear transducer (BS3C673 Convex Array, 3.5 MHz, BSUS20-32C; Broadsound Corporation, Taiwan). Rate of 22.5 frames/second.	Submandibular area	Amplitude	Unspecified	Not investigated
	10 received traditional therapy and biofeedback (experimental group)
	10 received traditional deglutition therapy (control group)
Macrae et al.⁽²³23 Macrae PR, Doeltgen SH, Jones RD, Huckabee ML. Intra- and inter-rater reliability for analysis of hyoid displacement measured with sonography. J Clin Ultrasound. 2012;40(2):74-8. http://dx.doi.org/10.1002/jcu.20874. PMid:21953135. http://dx.doi.org/10.1002/jcu.20874... ⁾, 2012, Estados Unidos	5 healthy adults between the ages of 20 and 50 years old:	Scanner IU22 Model (Philips Ultrasound, Bothell, WA) with a 5-1 MHz curved array transducer.	Submandibular area	Amplitude	Amplitude was defined as the point at which the acoustic shadow intersects with the geniohyoid muscle. Each evaluator identified a "rest" frame before any deglutition-related oral movement of interest and a "maximum amplitude" frame. Electronic calipers were used to measure the distance between the reference point and the point of maximum amplitude. The quantification of the HB movement or the change from resting distance to amplitude distance were calculated as a percentage of the distance traveled from rest and as an absolute value of the distance traveled.	Inter-examiner ICC for percent change of hyoid position = 0.70
	02 men					Inter-examiner ICC for absolute change of hyoid position = 0.64
	03 women,					Intra-examiner ICC for percent change of hyoid position = 0.93
						Intra-examiner ICC for absolute change of hyoid position = 0.90
Matsuo e Matsuyama⁽³²32 Matsuo T, Matsuyama M. Detection of poststroke oropharyngeal dysphagia with swallowing screening by ultrasonography. PLoS One. 2021;16(3):e0248770. http://dx.doi.org/10.1371/journal.pone.0248770. PMid:33730038. http://dx.doi.org/10.1371/journal.pone.0... ⁾, 2021, Japan	36 participants:	Color Doppler Ultrasound System JS2 Digital Model (SonoScape Medical Corp, Centennial, CO, USA). 5 to 12 MHz transducer	Larynx (thyroid cartilage on the left or right)	Amplitude in the lifting and return phases	The acquired images were analyzed using	Not investigated
	18 healthy elderly men				two-dimensional data analysis software (Dipp Motion Ver 1.1.31; DITECT Co., Tokyo, Japan). The measurement point was the lower anterior margin of the HB. The vertical and anteroposterior directions were considered as
	18 male patients with stroke and diagnosis of neurogenic oropharyngeal dysphagia.				the x and y axes, respectively, and the distances moved in these directions were measured. The amplitude of movement of the HB and larynx were measured in the phases of lifting and lowering. The movement rate was calculated by dividing the bone movement (lifting phase) by the laryngeal movement (lifting phase) as the deglutition index.
Matsuo et al.⁽¹³13 Matsuo T, Matsuyama M, Nakatani K, Mori N. Evaluation of swallowing movement using ultrasonography. Radiological Phys Technol. 2020;13(1):62-8. http://dx.doi.org/10.1007/s12194-019-00547-1. PMid:31786806. http://dx.doi.org/10.1007/s12194-019-005... ⁾, 2019, Japan	84 participants:	Color Doppler Ultrasound System JS2 Digital Model (SonoScape Medical Corp, Centennial, CO, USA). 5 to 12 MHz transducer	Larynx (thyroid cartilage on the left or right)	Amplitude	Amplitude was measured in both lifting and return phases defined as the period from the starting point to the position of maximum movement and the period from this position back to the rest position, respectively. The acquired images were converted into audio and video intermingle format and were analyzed using two-dimensional data analysis software (Dipp Motion Ver 1.1.31; DITECT Co, Tokyo, Japan). Markers were set at the lower anterior margin of the HB and the final upper part of the larynx, and the measurement points were automatically tracked in each frame using the tracking function of the analysis software. Vertical and anteroposterior directions were considered the x and y axes, respectively, and the distances moved in these directions were measured.	Not investigated
	42 young adults (20.3 ± 3.4 years old)
	42 elderly (75.1 ± 10.6 years old).
Perry et al.⁽³³33 Perry SE, Winkelman CJ, Huckabee ML. Variability in ultrasound measurement of hyoid bone displacement and submental muscle size using 2 methods of data acquisition. Folia Phoniatr Logop. 2016;68(5):205-10. http://dx.doi.org/10.1159/000473876. PMid:28456801. http://dx.doi.org/10.1159/000473876... ⁾, 2017, New Zealand	24 healthy participants (age 51-84 years old):	ACUSON Antares TM Model (ACUSON Antares TM 5.0 Premium Edition; Siemens Healthcare, Malvern, PA, USA) in 2D imaging function, mode B.	Submandibular area	Amplitude	For amplitude, two reference points were identified: (1) the intersection of the posterior edge of the shadow of the mental symphysis and the inferior portion of the geniohyoid muscle; and (2) the intersection of the anterior edge of the HB's bone shadow and the superior portion of the geniohyoid muscle. The frame that showed the greatest distance between these references (HB at rest) and the frame where the distance was smaller (maximum course). The distance between the two reference points was measured for rest and maximum amplitude. Images were imported into a Digital Imaging and Communications in Medicine (DICOM) viewer program (OsiriX MD; Pixmeo SARL, Bernex, Switzerland) on a computer (iMac; Apple Inc., Cupertino, CA, USA) for analysis.	Not investigated
	11 men
	13 women
Rocha et al.⁽³⁴34 Rocha SG, Silva RG, Berti LC. Qualitative and quantitative ultrasound analysis of oropharyngeal swallowing. CoDAS. 2015;27(5):437-45. http://dx.doi.org/10.1590/2317-1782/20152015015. PMid:26648214. http://dx.doi.org/10.1590/2317-1782/2015... ⁾, 2015, Brazil	100 healthy individuals stratified into 04 groups with 25 people each:	DP 6600 Model, micro-convex transducer coupled to	Submandibular area	Amplitude	The images were captured and subsequently analyzed using AAA (Articulate Assistant Advanced) Software. The amplitude between the lower part of the hyoid and the insertion of the mylohyoid muscle from the resting position was considered for maximum anteriorization.	Not investigated
	20 to 30 years old	a computer and head stabilizer.
	31 to 40 years old
	41 to 50 years old
	51 to 60 years old
Shawker et al.⁽³⁶36 Sonies BC, Ph D, Parent LJ, Morrish K, Ph D, Baum BJ, et al. Durational aspects of the oral-pharyngeal phase of swallow in normal adults. Dysphagia. 1988;3(1):1-10. http://dx.doi.org/10.1007/BF02406274. PMid:3073915. http://dx.doi.org/10.1007/BF02406274... ⁾, 1984, USA	10 healthy individuals (average age 24.8 years old)	Mechanical sector scanner model (Advanced Technology Laboratory) with 3mhz transducer, 80° sector angle and 30 frames/second rate.	Submandibular area	Time	Unspecified	Not investigated
	04 men
	06 women
Sonies et al.⁽³⁶36 Sonies BC, Ph D, Parent LJ, Morrish K, Ph D, Baum BJ, et al. Durational aspects of the oral-pharyngeal phase of swallow in normal adults. Dysphagia. 1988;3(1):1-10. http://dx.doi.org/10.1007/BF02406274. PMid:3073915. http://dx.doi.org/10.1007/BF02406274... ⁾, 1988, USA	47 healthy individuals (ages between 18-75 years old)	Mechanical sector scanner model (Advanced Technology Laboratory) with 3mhz transducer, 80° sector angle and 30 frames/second rate.	Submandibular area	Time	The duration measures of each deglutition were made from a frame-by-frame analysis of the videos, using a 10-second Sony video card. The time was measured from the moment the HB first moved anteriorly and superiorly from rest until its return to the stable rest position. The HB's movement was classified into four distinct phases and each phase was measured: from rest to anterior amplitude; time that the HB remained stable in the anterior amplitude; return to rest and total time.
	47 healthy individuals (ages between 18-75 years old)		Submandibular area	Time
Sonies et al.⁽³⁷37 Sonies BC, Wang C, Sapper DJ. Evaluation of normal and abnormal hyoid bone movement during swallowing by use of ultrasound duplex-Doppler imaging. Ultrasound Med Biol. 1996;22(9):1169-75. http://dx.doi.org/10.1016/S0301-5629(96)00158-5. PMid:9123641. http://dx.doi.org/10.1016/S0301-5629(96)... ⁾, 1996, USA	6 healthy volunteers:	Scanner ATL Ultramark 9 HDI Model	Submandibular area	Time	The images were scanned using a Scion LG-3 frame capture card on a Macintosh computer. The time intervals between markers A and B, B and C, and C and D were measured. A corresponds to the beginning of the HB movement, B indicates maximum lifting and beginning of the anterior movement, C corresponds to the anterior amplitude and beginning of the turning movement, and D indicates the completion of the return to the original rest position. From these measures, the durations for different phases of the movement were determined. The total movement time was calculated by the interval from A to D. The HB course was determined by tracking the movement in the HB muscle insertion region. The position of the HB during each deglutition was traced showing the way. A triangular course was used as a model to adjust the data, which allowed to calculate the movements during all phases.	Not investigated
	04 men	(Advanced Technology Laboratories, Inc., Bothell,		Amplitude
	02 women	WA, USA). Curved array transducer with operating frequency of 5.0-9.0 MHz and a Doppler frequency of 5.0 MHz.		Velocity
Steele et al.⁽³⁸38 Steele C, Sasse C, Bressmann T. Tongue-pressure and hyoid movement timing in healthy liquid swallowing. Int J Lang Commun Disord. 2012;47(1):77-83. http://dx.doi.org/10.1111/j.1460-6984.2011.00082.x. PMid:22268903. http://dx.doi.org/10.1111/j.1460-6984.20... ⁾, 2012, Canada	20 healthy young adults (age 20 to 39 years old:	GE LOGIQ alpha Model 100 MP Scanner (General Electric Medical	Submandibular area (no precise description of positioning)	Time	The recordings were analyzed in a similar way (frame by frame) to identify the temporal limits of movement of the acoustic shadow as follows: H1: First video frame showing anterior movement	Not investigated
	ten men	Systems, WI, USA) with 6.5 MHz E72 micro-convex transducer. Rate of 22.5 frames/second.			of the acoustic shadow during a deglutition; H2: final video frame before the posterior movement of the acoustic shadow during a deglutition; H3: First video frame showing the arrival of the HB shadow back in a stable resting position after swallowing. All values were converted to milliseconds to allow calculation of three time difference measurements.
	ten women
Stone and Shawker⁽³⁹39 Stone M, Shawker TH. An ultrasound examination of tongue movement during swallowing. Dysphagia. 1986;1(2):78-83. http://dx.doi.org/10.1007/BF02407118. PMid:3527582. http://dx.doi.org/10.1007/BF02407118... ⁾, 1986, USA.	6 healthy adult women (ages between 20-40 years old).	Advanced Technology Laboratories, Inc. Model (Bellevue, WA). Mechanical sector scanner with rotating panel	Submandibular area	Time	The duration of the lifting, holding and return phases of each stage of laryngeal movement was determined by observing the HB movement and its acoustic shadow. The time was timed to hundredths of a second and digitally inserted into the videotape, marking each frame with a separate time and facilitating the analysis of the measures.	Not investigated
		head with three 3 MHz transducers spaced at 120 ~ around a
		central axis
Winiker et al.⁽⁴⁰40 Winiker K, Burnip E, Gozdzikowska K, Guiu Hernandez E, Hammond R, Macrae P, et al. Ultrasound: validity of a pocket-sized system in the assessment of swallowing. Dysphagia. 2021;36(6):1010-8. http://dx.doi.org/10.1007/s00455-020-10232-w. PMid:33389177. http://dx.doi.org/10.1007/s00455-020-102... ⁾, 2021,	20 healthy adults.	Clarius ™ Curvilinear Model (C3, Clarius, Burnaby, British Columbia, Canada; frequency range: 2-6 MHz,	Submandibular area	Amplitude	The amplitude peak position was defined as the frame with the shortest distance between the acoustic shadow of the HB and the acoustic shadow of the mental spine of the mandible. The extent of movement of the HB was expressed as a percentage of the distance in amplitude since rest (rest distance between the mental spine of the mandible and the HB - maximum distance between the two structures) / rest distance between the two structures) × 100.	Intra-examiner ICC = 0.25 (0.00-0.78)
	20 healthy adults.	depth: 3-30 cm, size: 169 mm × 105 mm × 41 mm).	Submandibular area	Amplitude		Inter-examiner ICC = 0.53 (0.01-0.83)
Yabunaka et al.⁽⁴¹41 Yabunaka K, Ohue M, Hashimoto T, Katsuda T, Yamamoto K, Sanada S. Sonographic analysis of hyoid bone movement during swallowing. IFMBE Proc. 2009;22:840-2. http://dx.doi.org/10.1007/978-3-540-89208-3_201. http://dx.doi.org/10.1007/978-3-540-8920... ⁾, 2009, Japan	15 healthy volunteers (average age 34.9 ± 9.3).	Xario Model (Toshiba Medical Systems, Tokyo, Japan) with	Larynx	Time	The images were analyzed by ImageJ software and the recordings were viewed at 30 frames/second for 3 seconds. Frames of the moving Image were analyzed and the amplitude of movement of the HB from the resting point was measured considering the X axis, horizontal migration length; and the Y axis, perpendicular migration length. The time intervals between markers A and B, B and C, and C and D were measured. A corresponds to the beginning of the HB movement, B indicates maximum lifting and beginning of the anterior movement, C corresponds to the anterior amplitude and beginning of the turning movement, and D indicates the completion of the return to the original rest position. The total movement time was calculated by the interval from A to D.	Not investigated
		curved array transducers (3.5-7.0 MHz) (PVT-674BT,		Amplitude
		Toshiba).
Yabunaka et al.⁽⁴²42 Yabunaka K, Sanada H, Sanada S, Konishi H, Hashimoto T, Yatake H, et al. Sonographic assessment of hyoid bone movement during swallowing: A study of normal adults with advancing age. Radiological Phys Technol. 2011;4(1):73-7. http://dx.doi.org/10.1007/s12194-010-0107-9. PMid:20945118. http://dx.doi.org/10.1007/s12194-010-010... ⁾, 2010, Japan	30 healthy volunteers:	Xario Model (Toshiba Medical Systems, Tokyo, Japan) with	Larynx	Time	The images were analyzed by ImageJ software and the recordings were viewed at 30 frames/second for 3 seconds. Frames of the moving Image were analyzed and the amplitude of movement of the HB from the resting point was measured considering the X axis, horizontal migration length; and the Y axis, perpendicular migration length. The time intervals between markers A and B, B and C, and C and D were measured. A corresponds to the beginning of the HB movement, B indicates maximum lifting and beginning of the anterior movement, C corresponds to the anterior amplitude and beginning of the turning movement, and D indicates the completion of the return to the original rest position. The total movement time was calculated by the interval from A to D. The maximum HB lifting point was measured from A to C in all individuals.	Not investigated
	15 men	curved array transducers (3.5-7.0 MHz) (PVT-674BT,		Amplitude
	15 women	Toshiba).
Cordaro and Sons⁽¹⁹19 Cordaro MA, Sonies BC. An image processing scheme to quantitatively extract and validate hyoid bone motion based on real-time ultrasound recordings of swallowing. IEEE Trans Biomed Eng. 1993;40(8):841-4. http://dx.doi.org/10.1109/10.238473. PMid:8258453. http://dx.doi.org/10.1109/10.238473... ⁾, 1993, USA	A healthy male individual	Ultramark 9 Model (Advanced Technology Laboratories; Bothell, WA) with a curved array transducer (IYT).	Submandibular area (no precise description of positioning)	Amplitude	The images were spatially calibrated by the centimeter scale displayed by the equipment by counting the number of pixels between the scale markers. The HB coordinates extracted from the videofluorographic images were transformed into the coordinate system of the USG images frame by frame to make a direct quantitative comparison of the position and course of the HB. This was achieved by extracting the center of the curved array of the USG transducer directly from the videofluorographic image.	Not investigated

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[1] Conflict of interests: nothing to declare.