Inclusion body myositis is a chronic progressive muscle disease that primarily affects middleaged and older adults aged 50 and older, and no curative treatment has been established. Dysphagia, which occurs in 40 ％of cases of inclusion body myositis, is primarily caused by degeneration and fibrosis of the cricopharyngeal muscles, leading to incomplete opening of the esophageal entrance. A characteristic feature is the presence of cricopharyngeal bar on video fluorography. In severe cases, worsening laryngeal elevation and reduced pharyngeal contraction force may complicate the condition, leading to prolonged and challenging treatment. In this report, we present a case where we performed cricopharyngeal myotomy and laryngeal elevation, combined with post-operative balloon dilatation of the-pharyngo-esophageal segment, resulting in relatively rapid improvement in dietary intake levels in a patient with dysphagia caused by inclusion body myositis.

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Inclusion body myositis（IBM）is a chronic inflammatory myopathy that predominantly affects individuals over the age of 50, often presenting with impaired opening of the esophageal inlet.
We report the case of an 82-year-old woman who had been diagnosed with IBM by a neurologist four years earlier and was referred to our department for evaluation of surgical options to improve her swallowing function. She had experienced dysphagia for two and a half years, initially managed with balloon dilation. However, the effectiveness of this treatment gradually declined, resulting in worsening sore throat and difficulty swallowing.Given the IBM-related obstruction at the esophageal inlet, the patientʼs preference to avoid a cervical incision, and concerns about surgical invasiveness at her advanced age, we elected to perform endoscopic cricopharyngeal myotomy（ECPM）.
Postoperatively, her recovery was uneventful, and she resumed oral intake by postoperative day 7. The procedure eliminated the need for further balloon dilations, and her Food Intake Level Scale（FILS）score improved from Level 8 to Level 9.
This case highlights ECPM as a safe and effective minimally invasive option for managing dysphagia in elderly patients with IBM.

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This paper reports effects of oral care with foam for an elderly person with severe aperture rejection. The subject was male in his 80s hospitalized for consciousness disturbance and bilateral pneumonia after drowning with which speech therapist intervened. His oral cavity functions were in a severe condition since 22/24 in Revised Oral Cavity Assessment Guide （ROAG）and 9.2 in Oral Moisture Checker Mucus®（Mucus）. Enforcement of conventional oral care was difficult due to severe aperture rejection. We focused on foam oral care in which foam occurred by stirring mouth-wash with a sponge brush is used for oral care. The foam used had adequate viscosity, and was applicable to cavitas oris propria of a patient rejecting aperture with syringe. ROAG and Mucus were improved to 8/24 and 30.5, respectively by continuous foam care. In comparison with the conventional mouth care, the amount of mouth-wash used and time required for care were reduced to 1/2 and 1/3, respectively by the foam care. A large quantity of air contained in the foam infiltrated intraoral accretion and raised the cleaning effects, we presume. Foam care is expected to be utilized more in cases facing difficulty in oral care in the future.

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Our hospitalʼs swallowing support team uses video-endoscopic evaluation of swallowing（VE） to assess inpatientsʼ oral intake and decide on the most appropriate swallowing training. We investigated six items related to the determination of food intake after VE（videoendoscopic examination score［VEES］, level of consciousness, serum albumin level, degree of residual jelly in the epiglottis vallecula, and in the piriform fossa, degree of penetration of thickened water into the larynx）, in all 488 VE cases performed from July 2022 to June 2023. There were statistically significant differences between patients without oral intake（60 cases）and patients with swallowing training（132 cases）for all items except serum albumin level. There were also significant differences between patients with swallowing training and those who started eating （296 cases）for all items. VEES is not the sole determining factor in whether a patient requires swallowing training. Even if the score is 6 or less, training is indicated for patients with poor albumin levels and consciousness. Similarly, patients with good albumin levels or who can swallow jelly or thickened water normally are also indicated for training, even if they have a score of 8 or more.

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Assessment and training of suprahyoid and infrahyoid muscle strength（SIMS）, which are crucial for hyolaryngeal elevation, are essential in dysphagia rehabilitation for elderly patients. However, objective methods for assessing SIMS remain underdeveloped. We developed and reported a novel SIMS measurement method using a dedicated neck attachment and a handheld dynamometer and evaluated its reliability. This study retrospectively examined its application in clinical settings.
Patient data, including SIMS values and other swallowing-related metrics, were collected from medical records of elderly patients. The SIMS measurement showed a higher measurability rate compared to other methods. A positive correlation was observed between improved SIMS and functional oral intake scale（FOIS）scores. SIMS also correlated positively with cough peak flow（CPF）and tongue pressure.
These findings suggest that SIMS measurement is feasible for clinical application and relates to swallowing function, including oral muscle strength, respiratory function, and nutritional intake levels. The objective assessment of SIMS could serve as a new indicator in dysphagia rehabilitation, particularly for elderly patients.

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