Use of an anatomical scalar to control for sex-based size differences in measures of hyoid excursion during swallowing

Purpose: Traditional methods for measuring hyoid excursion from dynamic videofluoroscopy recordings involve calculating changes in position in absolute units (mm). This method shows a high degree of variability across studies but agreement that greater hyoid excursion occurs inmen than in women. Given that men are typically taller than women, the authors hypothesized that controlling for participant size might neutralize apparent sex-based differences in hyoid excursion. Method: Hyoid excursion in 20 young (<45) healthy volunteers (10 male), stratified by height, was measured in a tightly controlled videofluoroscopic protocol. Results: The study identified an anatomical scalar (C2-C4 length), visible on the videofluoroscopic image, correlated with participant height. This scalar differed significantly between men and women. By incorporating the anatomical scalar as a continuous covariate in repeated measures mixed-model analyses of variance of hyoid excursion, apparent sex-based differences were neutralized. Transforming measures of hyoid excursion into anatomically scaled units achieved the same result, reducing variation attributable to sex-based differences in participant size. Conclusions: Hyoid excursion during swallowing is dependent on a person's size. If measurements do not control for this source of variation, apparent sex differences in hyoid excursion are seen.