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Gao M, Inamoto Y, Saitoh E, Aihara K, Shibata S, Gonzalez-Fernandez M, Otaka Y. Location of the upper oesophageal sphincter during swallowing: Analysis using swallowing CT. J Oral Rehabil 2024; 51:1193-1201. [PMID: 38570928 DOI: 10.1111/joor.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/21/2023] [Accepted: 03/09/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Upper oesophageal sphincter (UES) serves as an important anatomical and functional landmark during swallowing. However, the precise UES location before and during swallowing has not been well established. OBJECTIVE This study aimed to determine upper oesophageal sphincter (UES) location and displacement during swallowing accounting for sex, age, and height in healthy adults using 320-row area detector computed tomography (320-ADCT). METHODS Ninety-four healthy adults (43 males; 22-90 years) underwent 320-ADCT scanning while swallowing one trial of 10 mL honey thick barium. UES location at bolus hold and at maximum displacement and vertical displacement during swallowing were identified using the coordinates and the section classification of vertebrae (VERT scale). The differences and correlations of UES location and distance in terms of sex, age, and height were analysed using Mann-Whitney U test and Spearman's correlation coefficient. RESULTS UES locations at bolus hold and at maximum displacement were significantly lower and UES vertical displacement was significantly larger in males than in females (p < .001). UES location at bolus hold became lower with increasing age (r = -.312, p = .002), but the negative correlation was low at maximum displacement (r = -.230, p = .026), resulting in larger vertical distance with ageing. UES locations showed high negative correlation at bolus hold with height (r = -.715, p < .001), and showed moderate negative correlation at maximum displacement with height (r = -.555, p < .001), although this effect was unclear when analysed by sex. CONCLUSION Males showed lower UES location and larger displacement than females. The impact of age was evident with lower location before swallowing and larger displacement during swallowing. Differences observed by sex were not completely explained by using the VERT scale to adjust for height.
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Affiliation(s)
- Minxing Gao
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Keiko Aihara
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Marlis Gonzalez-Fernandez
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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Edeani FO, Kern M, Ulualp K, Kovacic K, Sanvanson P, Mei L, Shaker R. Variables influencing manometric parameters of deglutitive and non-deglutitive upper esophageal sphincter: A study of 89 asymptomatic participants. Neurogastroenterol Motil 2022; 34:e14175. [PMID: 34431179 PMCID: PMC10128622 DOI: 10.1111/nmo.14175] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/19/2021] [Accepted: 04/28/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND High-resolution manometry overcomes limitations imposed by axial and radial asymmetry as well as swallow and respiration-induced movement of the upper esophageal sphincter (UES), allowing for its reliable use in evaluation of dysphagic and reflux patients. The aim of this study was to determine normative values and their variability across position, sex, age, height, weight, BMI, and volume for clinically relevant deglutitive and non-deglutitive UES parameters. METHODS We studied 89 asymptomatic volunteers age 19-90 years, (45 female) during 3-10 repetitions of dry, 5 and 10 ml water swallows at 30-s intervals using high-resolution manometry. KEY RESULTS Upper esophageal sphincter high-pressure zone was longer in men than women and in supine than upright position. UES basal contractile integral and mean basal pressure were higher in supine compared to upright; higher in men than women, inversely correlated with age, correlated positively with height and with weight in the supine position only. UES relaxation duration was longer in upright than in supine position but not affected by age, sex, height, weight, or BMI. It was longer with 5 and 10 ml compared with dry swallows. UES minimum/nadir relaxation and mean relaxation pressures were lower in upright than supine position, increased with increase in age and were higher in men than women. CONCLUSIONS AND INFERENCES Position, sex, age, height, weight, and volume affect some deglutitive and non-deglutitve UES manometric parameters. BMI does not affect the studied manometric parameters. These effects should be taken into consideration in clinical evaluation of UES.
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Affiliation(s)
- Francis O Edeani
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mark Kern
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kenan Ulualp
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Karlo Kovacic
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Patrick Sanvanson
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ling Mei
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Reza Shaker
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
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Jones CA, Colletti CM. Age-Related Functional Reserve Decline Is Not Seen in Pharyngeal Swallowing Pressures. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:3734-3741. [PMID: 34525307 PMCID: PMC9132052 DOI: 10.1044/2021_jslhr-21-00164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Purpose Functional reserve represents the difference between an individual's ability to produce a maximum output function and the ability to perform a functional task. Several studies have documented an age-related decrease in functional reserve with oral tongue pressure generation. Whether this pattern is seen in pharyngeal swallowing pressures is unknown. The aim of this study was to investigate pharyngeal functional reserve using high-resolution manometry during normal-effort and effortful swallows. Method Pharyngeal high-resolution manometry was performed on 38 younger healthy individuals (≤ 40 years) and 18 older healthy individuals (≥ 60 years) during normal-effort and effortful water swallows. Pressure metrics included maximum pressure in the velopharynx, tongue base, and hypopharynx, as well as pharyngeal contractile integral and minimum pressure in the upper esophageal sphincter (UES). Repeated-measures analysis of variance was used to determine the effects of swallow task, age, and pharyngeal region on pressure generation. Results Maximum pharyngeal pressures and pharyngeal contractile integral were significantly increased during the effortful swallows compared to normal-effort swallows (p < .001), but there were no interactions between task and age in pharyngeal pressures. In the UES, minimum pressures were significantly elevated in older individuals during effortful swallows compared to normal-effort swallows (p = .007) but did not follow a pattern consistent with reduced functional reserve. Conclusions Healthy individuals increase pharyngeal driving pressures during effortful swallows, without an age-related reduction in the magnitude of pressure increase. Thus, this study did not find evidence for an age-related reduction in pharyngeal functional reserve. The preserved ability to increase pharyngeal pressures during effortful swallowing in aging may support the use of behavioral swallowing interventions in older individuals without neuromuscular conditions. Supplemental Material https://doi.org/10.23641/asha.16606709.
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Affiliation(s)
- Corinne A. Jones
- Department of Neurology, Dell Medical School, The University of Texas at Austin
- Department of Speech, Language, and Hearing Sciences, Moody College of Communication, The University of Texas at Austin
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4
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Groher ME. Normal Swallowing in Adults. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A Systematic Review of Physiological Changes in Swallowing in the Oldest Old. Dysphagia 2019; 35:509-532. [PMID: 31489507 DOI: 10.1007/s00455-019-10056-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/21/2019] [Indexed: 02/02/2023]
Abstract
Age-related swallowing changes are well-researched in deglutology, usually distinguishing those over 60 years as older aged. World-wide, older adults are healthier and forecast to live longer: many over 85 years. It is necessary for clinicians to understand healthy swallowing changes in this 'oldest old' in order to appropriately manage swallowing complaints in older patients. This systematic review collated and critically appraised studies investigating swallowing changes in adults over 85 years using instrumental assessment. Criteria for inclusion were healthy subjects over 85 years. Exclusion criteria included studies focused on anatomy and oral processing. Studies published until December 2018 were retrieved from BIOSIS, CINAHL, Embase, Medline, and Scopus, totaling 2125 articles. During data screening, 64% of studies investigating age-related swallowing changes were excluded, as the oldest old were not recruited. After PRISMA screening, 44 articles met criteria. These were further reviewed for data extraction, bias and quality. Main quantitative age-related changes in swallowing included increases in delay in swallow onset, bolus transit times, duration of UES opening, pressure above the UES and UES relaxation pressure, and reduction in pressure at the UES. Few studies detected increased residue or airway compromise in the form of aspiration. Results were not easily comparable due to differences in age ranges, methods for deeming participants 'healthy', measures used to define swallowing physiology, and swallowing tasks. Age-related swallowing changes are identified that do not compromise safety. The oldest old are underrepresented in normative deglutition research. It is essential future studies plan accordingly to recruit those over 85 years.
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Herzberg EG, Lazarus CL, Steele CM, Molfenter SM. Swallow Event Sequencing: Comparing Healthy Older and Younger Adults. Dysphagia 2018; 33:759-767. [PMID: 29687354 PMCID: PMC6201283 DOI: 10.1007/s00455-018-9898-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/16/2018] [Indexed: 12/16/2022]
Abstract
Previous research has established that a great deal of variation exists in the temporal sequence of swallowing events for healthy adults. Yet, the impact of aging on swallow event sequence is not well understood. Kendall et al. (Dysphagia 18(2):85-91, 2003) suggested there are 4 obligatory paired-event sequences in swallowing. We directly compared adherence to these sequences, as well as event latencies, and quantified the percentage of unique sequences in two samples of healthy adults: young (< 45) and old (> 65). The 8 swallowing events that contribute to the sequences were reliably identified from videofluoroscopy in a sample of 23 healthy seniors (10 male, mean age 74.7) and 20 healthy young adults (10 male, mean age 31.5) with no evidence of penetration-aspiration or post-swallow residue. Chi-square analyses compared the proportions of obligatory pairs and unique sequences by age group. Compared to the older subjects, younger subjects had significantly lower adherence to two obligatory sequences: Upper Esophageal Sphincter (UES) opening occurs before (or simultaneous with) the bolus arriving at the UES and UES maximum distention occurs before maximum pharyngeal constriction. The associated latencies were significantly different between age groups as well. Further, significantly fewer unique swallow sequences were observed in the older group (61%) compared with the young (82%) (χ2 = 31.8; p < 0.001). Our findings suggest that paired swallow event sequences may not be robust across the age continuum and that variation in swallow sequences appears to decrease with aging. These findings provide normative references for comparisons to older individuals with dysphagia.
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Affiliation(s)
- Erica G Herzberg
- Department of Communicative Sciences and Disorders, NYU Steinhardt, New York, NY, USA.
| | | | - Catriona M Steele
- Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Sonja M Molfenter
- Department of Communicative Sciences and Disorders, NYU Steinhardt, New York, NY, USA
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Cock C, Omari T. Systematic Review of Pharyngeal and Esophageal Manometry in Healthy or Dysphagic Older Persons (>60 years). Geriatrics (Basel) 2018; 3:geriatrics3040067. [PMID: 31011102 PMCID: PMC6371098 DOI: 10.3390/geriatrics3040067] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/15/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023] Open
Abstract
We undertook a systematic review of swallowing biomechanics, as assessed using pharyngeal and esophageal manometry in healthy or dysphagic older individuals aged over 60 years of age, comparing findings to studies of younger participants. PRISMA-P methodology was used to identify, select, and evaluate eligible studies. Across studies, older participants had lower upper esophageal sphincter (UES) resting pressures and evidence of decreased UES relaxation when compared to younger groups. Intrabolus pressures (IBP) above the UES were increased, demonstrating flow resistance at the UES. Pharyngeal contractility was increased and prolonged in some studies, which may be considered as an attempt to compensate for UES flow resistance. Esophageal studies show evidence of reduced contractile amplitudes in the distal esophagus, and an increased frequency of failed peristaltic events, in concert with reduced lower esophageal sphincter relaxation, in the oldest subjects. Major motility disorders occurred in similar proportions in older and young patients in most clinical studies, but some studies show increases in achalasia or spastic motility in older dysphagia and noncardiac chest pain patients. Overall, study qualities were moderate with a low likelihood of bias. There were few clinical studies specifically focused on swallowing outcomes in older patient groups and more such studies are needed.
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Affiliation(s)
- Charles Cock
- Department of Gastroenterology and Hepatology, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia.
| | - Taher Omari
- Department of Gastroenterology and Hepatology, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia.
- Department of Human Physiology, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia.
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Hara K, Tohara H, Minakuchi S. Treatment and evaluation of dysphagia rehabilitation especially on suprahyoid muscles as jaw-opening muscles. JAPANESE DENTAL SCIENCE REVIEW 2018; 54:151-159. [PMID: 30302133 PMCID: PMC6175969 DOI: 10.1016/j.jdsr.2018.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 12/02/2022] Open
Abstract
In our aging society, the number of patients with dysphagia, which is associated with disease and aging, is rapidly increasing. The swallowing reflex is a complex process that involves coordinated contractions of swallowing muscles. Many researchers have reported that age-related changes, such as frailty and sarcopenia, affect swallowing muscles and contribute to the decline in the swallowing function. Thus, simple, non-invasive evaluation methods and exercises for swallowing muscles in elderly patients with dysphagia are important. Anterior–superior hyolaryngeal elevation during swallowing results from contractions of the suprahyoid muscle, which plays a primary role in opening the upper esophageal sphincter, along with relaxation of the cricopharyngeal muscle and laryngeal closure. Thus, many researchers have studied methods for evaluating and augmenting suprahyoid muscles. On the other hand, some researchers have reported on dysphagia rehabilitation focused on jaw-opening actions, because hyolaryngeal elevation muscles correspond with jaw-opening muscles. In this study, we describe a new dysphagia evaluation method and an exercise that focuses on suprahyoid muscles with application of jaw-opening actions.
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9
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High-Resolution Manometry of the Pharynx and Esophagus. Dysphagia 2018. [DOI: 10.1007/174_2018_177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Nadaleto BF, Herbella FAM, Pinna BR, Patti MG. Upper esophageal sphincter motility in gastroesophageal reflux disease in the light of the high-resolution manometry. Dis Esophagus 2017; 30:1-5. [PMID: 28375485 DOI: 10.1093/dote/dox001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Indexed: 12/11/2022]
Abstract
This study aims to evaluate the upper esophageal sphincter (UES) motility in patients with gastroesophageal reflux disease (GERD) as compared to healthy volunteers. We retrospectively studied the HRM tests of 44 patients (median age: 61 years, 54% females) under evaluation for GERD. The manometric UES parameters of these patients were compared to 40 healthy volunteers (median age: 27 years, 50% females). Almost half of the patients had a short and hypotonic UES. Patients with extraesophageal symptoms had a higher proportion of hypotonic UES as compared to patients with esophageal symptoms. Reflux pattern did not influence manometric parameters. Proximal reflux (any number of episodes) was present in 37(84%) patients (median number of proximal episodes = 6). Manometric parameters are similar in the presence or absence of proximal reflux. There is not a correlation between the UES length and UES basal pressure. In conclusion, our results show that: (1) the manometric profile of the UES in patients with GERD is characterized by a short and hypotonic UES in half of the patients; (2) this profile is more pronounced in patients with extraesophageal symptoms; and (3) neither the presence of proximal reflux nor reflux pattern bring a different manometric profile.
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Affiliation(s)
- B F Nadaleto
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - F A M Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - B R Pinna
- Department of Ear, Nose and Throat, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - M G Patti
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
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Nakato R, Manabe N, Kamada T, Matsumoto H, Shiotani A, Hata J, Haruma K. Age-Related Differences in Clinical Characteristics and Esophageal Motility in Patients with Dysphagia. Dysphagia 2016; 32:374-382. [DOI: 10.1007/s00455-016-9763-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/22/2016] [Indexed: 12/14/2022]
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Giraldo-Cadavid LF, Leal-Leaño LR, Leon-Basantes GA, Bastidas AR, Garcia R, Ovalle S, Abondano-Garavito JE. Accuracy of endoscopic and videofluoroscopic evaluations of swallowing for oropharyngeal dysphagia. Laryngoscope 2016; 127:2002-2010. [DOI: 10.1002/lary.26419] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/19/2016] [Accepted: 10/12/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Luis Fernando Giraldo-Cadavid
- Research Department; University of La Sabana School of Medicine; Chía Colombia
- Clinical Training Unit; University of Navarra, School of Medicine; Pamplona Spain
- Research Department; Fundacion Neumologica Colombiana; Bogotá Colombia
| | | | | | | | - Rafael Garcia
- Research Department; University of La Sabana School of Medicine; Chía Colombia
| | - Sergio Ovalle
- Research Department; University of La Sabana School of Medicine; Chía Colombia
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Nativ-Zeltzer N, Logemann JA, Zecker SG, Kahrilas PJ. Pressure topography metrics for high-resolution pharyngeal-esophageal manofluorography-a normative study of younger and older adults. Neurogastroenterol Motil 2016; 28:721-31. [PMID: 26822009 PMCID: PMC4892368 DOI: 10.1111/nmo.12769] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/11/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND We aimed to define normative values for novel pressure topography metrics for high-resolution pharyngeal-esophageal manofluorography. The effects of age, gender, and bolus properties were examined. METHODS Concurrent high-resolution manometry (HRM) and videofluoroscopy data were collected from 22 younger (aged 21-40) and 22 older (aged 60-80) healthy subjects. Pressure topography was analyzed by correlating pressure domains with videofluoroscopic events. Nine pressure topography metrics of the pharyngeal and proximal esophageal swallow were extracted; four of these were also compared with previously obtained esophageal HRM studies to assess the effects of catheter diameter. KEY RESULTS Older individuals exhibited more vigorous contractility in the pharynx than did younger subjects with all bolus types, but the greatest values for both groups were with effortful swallow and on that measure the age groups were similar. Upper esophageal sphincter (UES) intrabolus pressure during sphincter opening was also greater in the older subjects. Some gender differences were observed, particularly related to proximal esophageal contractile vigor. Bolus consistency had no consistent effect. Studies using the larger catheter diameter resulted in significantly greater contractile vigor in the UES and proximal esophagus. CONCLUSIONS & INFERENCES Older adults exhibited more vigorous pharyngeal contractions than young adults, albeit within a similar range of capacity, perhaps reflecting a compensatory response to other age-related physiological changes. Greater UES intrabolus pressures observed during bolus transit in the older group likely reflect reduced UES compliance with age. Normative data on novel HRM metrics collected in this study can serve as a reference for future clinical studies.
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Affiliation(s)
| | - Jeri A. Logemann
- Department of Communication Sciences and Disorders, Evanston, Illinois
| | - Steven G. Zecker
- Department of Communication Sciences and Disorders, Evanston, Illinois
| | - Peter J. Kahrilas
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A
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Shiino Y, Sakai S, Takeishi R, Hayashi H, Watanabe M, Tsujimura T, Magara J, Ito K, Tsukada T, Inoue M. Effect of body posture on involuntary swallow in healthy volunteers. Physiol Behav 2016; 155:250-9. [PMID: 26742532 DOI: 10.1016/j.physbeh.2015.12.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/23/2015] [Accepted: 12/24/2015] [Indexed: 11/29/2022]
Abstract
Clinically, reclining posture has been reported to reduce risk of aspiration. However, during involuntary swallow in reclining posture, changes in orofacial and pharyngeal movement before and during pharyngeal swallow should be considered. Further, the mechanisms underlying the effect of body posture on involuntary swallow remain unclear. The aim of the present study was to determine the effect of body posture on activity patterns of the suprahyoid muscles and on patterns of bolus transport during a natural involuntary swallow. Thirteen healthy male adults participated in a water infusion test and a chewing test. In the water infusion test, thickened water was delivered into the pharynx at a very slow rate until the first involuntary swallow was evoked. In the chewing test, subjects were asked to eat 10 g of gruel rice. In both tests, the recording was performed at four body postures between upright and supine positions. Results showed that reclining changed the location of the bolus head at the start of swallow and prolonged onset latency of the swallowing initiation. Muscle burst duration and whiteout time measured by videoendoscopy significantly increased with body reclining and prolongation of the falling time. In the chewing test, reclining changed the location of the bolus head at the start of swallow, and the frequency of bolus residue after the first swallow increased. Duration and area of EMG burst and whiteout time significantly increased with body reclining. These data suggest that body reclining may result in prolongation of pharyngeal swallow during involuntary swallow.
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Affiliation(s)
- Yoshitaka Shiino
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan; Department of Rehabilitation, Takeda General Hospital, 3-27 Yamaga-machi, Fukushima 965-8585, Japan
| | - Shogo Sakai
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
| | - Ryosuke Takeishi
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
| | - Hirokazu Hayashi
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
| | - Masahiro Watanabe
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
| | - Kayoko Ito
- Oral Rehabilitation, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata 951-8520, Japan
| | - Tetsu Tsukada
- Department of Rehabilitation, Takeda General Hospital, 3-27 Yamaga-machi, Fukushima 965-8585, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan.
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Machida N, Tohara H, Hara K, Kumakura A, Wakasugi Y, Nakane A, Minakuchi S. Effects of aging and sarcopenia on tongue pressure and jaw-opening force. Geriatr Gerontol Int 2016; 17:295-301. [DOI: 10.1111/ggi.12715] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Nami Machida
- Department of Gerontology and Gerodontology; Tokyo Medical and Dental University; Tokyo Japan
| | - Haruka Tohara
- Department of Gerontology and Gerodontology; Tokyo Medical and Dental University; Tokyo Japan
| | - Koji Hara
- Department of Gerontology and Gerodontology; Tokyo Medical and Dental University; Tokyo Japan
| | - Ayano Kumakura
- Dysphagia Rehabilitation; Nihon University School of Dentistry; Tokyo Japan
| | - Yoko Wakasugi
- Department of Gerontology and Gerodontology; Tokyo Medical and Dental University; Tokyo Japan
| | - Ayako Nakane
- Department of Gerontology and Gerodontology; Tokyo Medical and Dental University; Tokyo Japan
| | - Shunsuke Minakuchi
- Department of Gerontology and Gerodontology; Tokyo Medical and Dental University; Tokyo Japan
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Groher ME. Normal Swallowing in Adults. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00002-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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NASCIMENTO WV, SANTOS CM, CASSIANI RA, DANTAS RO. INFLUENCE OF AGE ON SWALLOWS OF A HIGHLY VISCOUS LIQUID BOLUS. ARQUIVOS DE GASTROENTEROLOGIA 2015; 52:32-6. [DOI: 10.1590/s0004-28032015000100008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/29/2014] [Indexed: 01/22/2023]
Abstract
Background Swallow function has a decline with aging, mainly in those over 80 years old. In the population over 69 years, about 11% of subjects reported symptoms indicative of significant dysphagia. Objectives Our objective was to evaluate the hypothesis that older asymptomatic subjects before 80 years old have compensations to sustain a safe and efficient swallow, at least with swallows of liquid bolus. Methods We performed videofluoroscopic evaluation of swallows in 55 normal volunteers, a younger group with 33 subjects (16 men and 17 women) aged 19 to 55 years, mean 35.5±9.8 years, and an older group with 22 subjects (15 men and 7 women) aged 56 to 77 years, mean 64.8±6.8 years. The subjects swallowed in duplicate 5 mL and 10 mL of liquid barium with a pH of 7.9, density of 1.82 g/cm3, and viscosity of 895 cp. Results The mean duration of pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were longer in the younger group compared with the older group. The relation between pharyngeal clearance duration and hyoid movement duration was similar in younger and older subjects, for 5 mL and 10 mL bolus volumes. Conclusions On average, a highly viscous liquid bolus crosses the pharynx faster in older subjects (56-77 years old) than in younger subjects (19-55 years old), which suggested an adaptation to the aging process to maintain a safe swallow.
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Fukuike C, Kodama N, Manda Y, Hashimoto Y, Sugimoto K, Hirata A, Pan Q, Maeda N, Minagi S. A novel automated detection system for swallowing sounds during eating and speech under everyday conditions. J Oral Rehabil 2014; 42:340-7. [PMID: 25545324 DOI: 10.1111/joor.12264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2014] [Indexed: 10/24/2022]
Abstract
The wave analysis of swallowing sounds has been receiving attention because the recording process is easy and non-invasive. However, up until now, an expert has been needed to visually examine the entire recorded wave to distinguish swallowing from other sounds. The purpose of this study was to establish a methodology to automatically distinguish the sound of swallowing from sound data recorded during a meal in the presence of everyday ambient sound. Seven healthy participants (mean age: 26·7 ± 1·3 years) participated in this study. A laryngeal microphone and a condenser microphone attached to the nostril were used for simultaneous recording. Recoding took place while participants were taking a meal and talking with a conversational partner. Participants were instructed to step on a foot pedal trigger switch when they swallowed, representing self-enumeration of swallowing, and also to achieve six additional noise-making tasks during the meal in a randomised manner. The automated analysis system correctly detected 342 out of the 352 self-enumerated swallowing events (sensitivity: 97·2%) and 479 out of the 503 semblable wave periods of swallowing (specificity: 95·2%). In this study, the automated detection system for swallowing sounds using a nostril microphone was able to detect the swallowing event with high sensitivity and specificity even under the conditions of daily life, thus showing potential utility in the diagnosis or screening of dysphagic patients in future studies.
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Affiliation(s)
- C Fukuike
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Liesenborghs C, Dejaeger E, Liesenborghs L, Tack J, Rommel N. Presbyfagie: de invloed van het primair verouderingsproces op de slikfunctie. Tijdschr Gerontol Geriatr 2014; 45:261-272. [PMID: 25246069 DOI: 10.1007/s12439-014-0094-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PRESBYPHAGIA: THE INFLUENCE OF PRIMARY AGING ON SWALLOWING FUNCTION: Elderly often get confronted with swallowing difficulties. It is important to differentiate between presbyphagia, which describes the influence of primary aging on swallow function and dysphagia, which is a pathological swallowing disorder caused by age related diseases and their treatment. In this literature overview the focus is on presbyphagia. The influence of primary aging on the oropharyngeal swallowing function and on other body functions that are indirectly related to swallowing will be discussed. From the literature we learn that in primary aging a number of functions stay preserved, a number of functions deteriorate, and some compensatory mechanisms are evident. The swallow safety as such however, stays preserved. To conclude with we discuss some clinical implications concerning both the detection of swallowing disorders in the elderly and the establishment of preventive action for the healthy elderly.
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Affiliation(s)
- C Liesenborghs
- Klinische en Experimentele Geneeskunde, Translationeel Onderzoek van Gastro-enterologische Aandoeningen (TARGID), Katholieke Universiteit (KU) Leuven, O&N I Herestraat 49 - bus 701, 3000, Leuven, Belgium,
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Lee TH, Lee JS, Park JW, Cho SJ, Hong SJ, Jeon SR, Kim WJ, Kim HG, Cho JY, Kim JO. High-resolution impedance manometry facilitates assessment of pharyngeal residue and oropharyngeal dysphagic mechanisms. Dis Esophagus 2014; 27:220-9. [PMID: 23855892 DOI: 10.1111/dote.12101] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The utility of high-resolution impedance manometry (HRIM) for evaluating oropharyngeal dysphagia (OPD) has been investigated. These approaches are limited because of the sophisticated methodology. A method of transforming HRIM into a simple and useful diagnostic tool for evaluating OPD is needed. A videofluoroscopic swallowing study (VFSS) and HRIM were performed by independent blinded examiners in 26 consecutive healthy volunteers (12 men; median age, 56.5 years) and 10 OPD patients (five men; median age, 59.5 years). Upper esophageal sphincter (UES) relaxation parameters were measured using a standard HRIM protocol. Peristalsis and bolus transit of the pharyngoesophageal (PE) segment were assessed using an HRIM-modified protocol in which the catheter was pulled back 10 cm. PE bolus transits were evaluated with an impedance contour pattern (linear vs. stasis) method. A significant difference was observed between the manometric measures of healthy volunteers and OPD patients for only the duration of pharyngeal contraction (0.49 ± 0.19 vs. 0.76 ± 0.33 s, P = 0.04). The percentage agreement and kappa value for detecting pharyngeal residue between the VFSS and the impedance analysis were 100% and 1.00, respectively. HRIM allowed for comprehensive assessment of abnormal pharyngeal components that caused pharyngeal residue on VFSS in two patients; reduced base of the tongue versus weak pharyngeal contraction in one, and reduced relaxation of the UES versus reduced laryngeal elevation in the remaining patient. Our findings demonstrated that HRIM using a simple methodology (i.e., pull-back of the catheter) detected pharyngeal residue through a simple analysis of the impedance contour pattern (linear vs. stasis). Furthermore, HRIM facilitated a comprehensive assessment of OPD mechanisms and recognition of subtle abnormalities not yet visible to the naked eye on VFSS.
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Affiliation(s)
- T H Lee
- Institute for Digestive Research, College of Medicine, Soonchunhyang University, Seoul, Republic of Korea
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Omari TI, Kritas S, Cock C, Besanko L, Burgstad C, Thompson A, Rommel N, Heddle R, Fraser RJL. Swallowing dysfunction in healthy older people using pharyngeal pressure-flow analysis. Neurogastroenterol Motil 2014; 26:59-68. [PMID: 24011430 DOI: 10.1111/nmo.12224] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/08/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Age-related loss of swallowing efficiency may occur for multiple reasons. Objective assessment of individual dysfunctions is difficult and may not clearly differentiate these from normal. Pharyngeal pressure-flow analysis is a novel technique that allows quantification of swallow dysfunction predisposing to aspiration risk based on a swallow risk index (SRI). In this study, we examined the effect of ageing on swallow function. METHODS Studies were performed in 68 healthy subjects aged 20-91 years (mean 59 years; 29 male), asymptomatic for oropharyngeal disease. Swallowing of liquid and viscous boluses was recorded with a pressure-impedance catheter. Indices of swallow function including the SRI, postswallow residues, upper esophageal sphincter opening and bolus transit time were derived using purpose designed software. KEY RESULTS Swallow function worsened with increasing age with a significant decline after 80 years. Higher SRI correlated with increasing age (r = 0.257, p < 0.05 for liquids and r = 0.361, p < 0.005 viscous bolus). Subjects over 80 years were overrepresented amongst those with an SRI considered diagnostically relevant (SRI > 15). In addition, upper esophageal sphincter opening was reduced and postswallow residues increased in older subjects. CONCLUSIONS & INFERENCES Pharyngeal pressure-flow analysis reveals multiple functional abnormalities in older individuals. The higher SRI levels seen in asymptomatic elders possibly reflect a loss of functional reserve with ageing. Automated impedance manometry analysis of swallow function may allow the risk of developing disordered swallowing to be quantified numerically.
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Affiliation(s)
- T I Omari
- Gastroenterology Unit, Women's and Children's Health Network, Adelaide, SA, Australia; School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia; Department of Gastroenterology and Hepatology, School of Medicine, Flinders University, Adelaide, SA, Australia
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Krarup AL, Liao D, Gregersen H, Drewes AM, Hejazi RA, McCallum RW, Vega KJ, Frazzoni M, Frazzoni L, Clarke JO, Achem SR. Nonspecific motility disorders, irritable esophagus, and chest pain. Ann N Y Acad Sci 2013; 1300:96-109. [PMID: 24117637 DOI: 10.1111/nyas.12244] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This paper presents commentaries on whether Starling's law applies to the esophagus; whether erythromycin affects esophageal motility; the relationship between hypertensive lower esophageal sphincter and vigorous achalasia; whether ethnic- and gender-based norms affect diagnosis and treatment of esophageal motor disorders; health care and epidemiology of chest pain; whether normal pH excludes esophageal pain; the role of high-resolution manometry in noncardiac chest pain; whether pH-impedance should be included in the evaluation of noncardiac chest pain; whether there are there alternative therapeutic options to PPI for treating noncardiac chest pain; and the usefulness of psychological treatment and alternative medicine in noncardiac chest pain.
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Affiliation(s)
- Anne Lund Krarup
- Mech-Sense, Department of Gastroenterology, Aalborg University, Aalborg, Denmark
| | - Donghua Liao
- Mech-Sense, Department of Gastroenterology, Aalborg University, Aalborg, Denmark
| | - Hans Gregersen
- Mech-Sense, Department of Gastroenterology, Aalborg University, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology, Aalborg University, Aalborg, Denmark
| | - Reza A Hejazi
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Richard W McCallum
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Kenneth J Vega
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Marzio Frazzoni
- Fisiopatologia Digestiva, Nuovo Ospedale S. Agostino, Modena, Italy
| | | | - John O Clarke
- Division of Gastroenterology, Johns Hopkins University, Baltimore, Maryland
| | - Sami R Achem
- Mayo College of Medicine, Mayo Clinic, Jacksonville, Florida
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Miller L, Clavé P, Farré R, Lecea B, Ruggieri MR, Ouyang A, Regan J, McMahon BP. Physiology of the upper segment, body, and lower segment of the esophagus. Ann N Y Acad Sci 2013; 1300:261-277. [PMID: 24117648 PMCID: PMC3889860 DOI: 10.1111/nyas.12250] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The following discussion on the physiology of the esophagus includes commentaries on the function of the muscularis mucosa and submucosa as a mechanical antireflux barrier in the esophagus; the different mechanisms of neurological control in the esophageal striated and smooth muscle; new insights from animal models into the neurotransmitters mediating lower esophageal sphincter (LES) relaxation, peristalsis in the esophageal body (EB), and motility of esophageal smooth muscle; differentiation between in vitro properties of the lower esophageal circular muscle, clasp muscle, and sling fibers; alterations in the relationship between pharyngeal contraction and relaxation of the upper esophageal sphincter (UES) in patients with dysphagia; the mechanical relationships between anterior hyoid movement, the extent of upper esophageal opening, and aspiration; the application of fluoroscopy and manometry with biomechanics to define the stages of UES opening; and nonpharmacological approaches to alter the gastroesophageal junction (GEJ).
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Affiliation(s)
- Larry Miller
- North Shore Long Island Jewish Medical Center, New Hyde Park, New York
| | - Pere Clavé
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
- Laboratori de Fisiologia Digestiva, Hospital de Mataró, Mataró, Spain
| | - Ricard Farré
- Center for Gastroenterological Research, Catholic University, Leuven, Belgium
| | - Begoña Lecea
- Laboratori de Fisiologia Digestiva, Hospital de Mataró, Mataró, Spain
| | - Michael R Ruggieri
- Department of Anatomy and Cell Biology, Temple University, Philadelphia, Pennsylvania
| | - Ann Ouyang
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Julie Regan
- Trinity Academic Gastroenterology Group, Tallaght Hospital, Dublin, Ireland
| | - Barry P McMahon
- Trinity Academic Gastroenterology Group, Tallaght Hospital, Dublin, Ireland
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Kubo LS, Nascimento WVD, Dantas RO. Efeito da idade, do sexo, da altura e do índice de massa corporal no tempo de sucção oral de líquido. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2013. [DOI: 10.1590/s1809-98232013000100002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar o efeito da idade, do sexo, da altura e do índice de massa corporal (IMC) no tempo de sucção oral de água em pessoas normais. MÉTODO: O método constou de, em duplicata, cronometrar o tempo de sucção contínua de 40 ml de água à temperatura ambiente, utilizando um canudo com 6 mm de diâmetro e outro com 3 mm de diâmetro. Cada voluntário foi avaliado sentado, com a cabeça formando um ângulo de 90º entre a mandíbula e o pescoço. Foi permitida a deglutição. Em um grupo de 15 indivíduos, foi avaliada a reprodutibilidade do teste em quatro dias diferentes. O trabalho incluiu 180 indivíduos, o grupo jovem (20 a 30 anos, 45 homens e 45 mulheres) e o grupo idoso (65 a 89 anos, 45 homens e 45 mulheres). RESULTADOS: Observou-se diferença significativa no tempo de sucção entre jovens e idosos, sendo maior para os idosos do que para os jovens. Com o canudo de menor diâmetro, as mulheres idosas tiveram maior tempo de sucção do que os homens idosos. Em mulheres jovens, foi encontrada correlação positiva entre o IMC e o tempo de sucção. Não se observou influência da altura. A repetição do estudo em quatro dias mostrou o mesmo resultado. CONCLUSÃO: Concluímos que o envelhecimento compromete a sucção de líquido, e que este comprometimento é maior nas mulheres do que nos homens. Em mulheres jovens, maior IMC está associado ao maior tempo de sucção.
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Litle VR, Rice TW. The Esophagus: Do Sex and Gender Matter? Semin Thorac Cardiovasc Surg 2011; 23:131-6. [DOI: 10.1053/j.semtcvs.2011.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2011] [Indexed: 01/18/2023]
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Doeltgen SH, Macrae P, Huckabee ML. Pharyngeal pressure generation during tongue-hold swallows across age groups. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2011; 20:124-130. [PMID: 21386045 DOI: 10.1044/1058-0360(2011/10-0067)] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE To compare the effects of the tongue-hold swallowing maneuver on pharyngeal pressure generation in healthy young and elderly research volunteers. METHOD Sixty-eight healthy research volunteers (young, n = 34, mean age = 26.8 years, SD = 5.5; elderly, n = 34, mean age = 72.6 years, SD = 4.8; sex equally represented) performed 5 noneffortful saliva swallows and 5 tongue-hold swallows each. Amplitude and duration of pharyngeal pressure were investigated during both swallowing conditions with solid-state pharyngeal manometry at the level of the oropharynx, hypopharynx, and upper esophageal sphincter (UES). RESULTS At both pharyngeal levels, tongue-hold swallows produced lower peak pressure compared with saliva swallows. During tongue-hold swallows, UES relaxation pressure was increased in the elders, whereas the younger group displayed a trend toward reduced relaxation pressure. Elderly individuals produced pressure longer during control swallows in the oropharynx and hypopharynx than young individuals. CONCLUSIONS The tongue-hold maneuver affects oropharyngeal and hypopharyngeal pressure in the young and elders in similar ways, whereas effects on UES peak relaxation pressure differ between age groups. Reduced pharyngeal peak pressure and increased UES relaxation pressure underscore the notion that tongue-hold swallows should not be performed when bolus is present. Long-term training effects remain to be investigated.
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Effect of gender on swallow event duration assessed by videofluoroscopy. Dysphagia 2009; 24:280-4. [PMID: 19241103 DOI: 10.1007/s00455-008-9202-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Accepted: 10/29/2008] [Indexed: 10/21/2022]
Abstract
There are data suggesting that women swallow liquids at a lower flow rate and ingest smaller volumes in each swallow than men. Our objective in this work was to compare swallowing in asymptomatic men and women by videofluoroscopy. We studied 18 men [age = 33-77 years, mean = 61 (10) years] and 12 women [age = 29-72 years, mean = 53 (15) years] who swallowed in duplicate 5 and 10 ml of liquid and paste barium boluses. None of the volunteers had dysphagia, neurologic diseases, or oral, pharyngeal, or esophageal diseases. The videofluoroscopic examination showed that for the 5-ml bolus, women had a longer oropharyngeal transit [liquid: men, 0.63 (0.21) s, women, 0.88 (0.39) s; paste: men, 0.64 (0.35) s, women, 0.94 (0.58) s], longer oral transit [liquid: men, 0.41 (0.21) s, women, 0.59 (0.35) s; paste: men, 0.39 (0.28) s, women, 0.59 (0.42) s], and longer pharyngeal clearance [liquid: men, 0.36 (0.11) s, women, 0.45 (0.16) s; paste: men, 0.42 (0.25) s, women, 0.56 (0.27) s] compared with men (p < 0.05). We conclude that there are differences in swallowing between men and women, with women having a longer oropharyngeal transit than men for a 5-ml bolus.
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Butler SG, Stuart A, Castell D, Russell GB, Koch K, Kemp S. Effects of age, gender, bolus condition, viscosity, and volume on pharyngeal and upper esophageal sphincter pressure and temporal measurements during swallowing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2009; 52:240-253. [PMID: 19064903 DOI: 10.1044/1092-4388(2008/07-0092)] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE The purpose of this study was to determine the effects of trial (i.e., Trial 1 vs. Trial 2); viscosity (i.e., saliva, thin, nectar-thick, honey-thick, and pudding-thick water); volume (i.e., 5 mL vs. 10 mL); age (i.e., young vs. older adults); and gender on pharyngeal (i.e., upper and lower) and upper esophageal sphincter (UES) pressures, durations, and onsets (i.e., onset of upper pharyngeal pressures relative to onsets of UES relaxations and onset of lower relative to upper pharyngeal pressures). METHOD Twenty-three young adults (M=30 years) and 21 older healthy adults (M=75 years) participated. Measurements were acquired with a 2.1-mm catheter during simultaneous manometric and endoscopic swallowing assessment. Participants contributed 18 swallows, affording a study total of 792 swallows for analyses. RESULTS There was no significant effect of trial on any measurement of pressure, duration, and onset (ps=.63, .39, and .71, respectively). It was found that viscosity, volume, age, and gender affected pressure, duration, and onset measurements (e.g., onset of upper pharyngeal pressures relative to onsets of UES relaxations) but in varying degrees relative to the location in the pharynx or UES and the type of measurement (e.g., pressure, onset). CONCLUSIONS Manometric measurements vary with respect to age, gender, and bolus variables and interactions of each. Consideration of these variables is paramount in understanding normal and pathological swallowing if manometry is to develop as a quantitative adjunct to videofluoroscopic and endoscopic swallowing tools.
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Affiliation(s)
- Susan G Butler
- Wake Forest University School of Medicine, Department of Otolaryngology Center for Voice and Swallowing Disorders, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Witte U, Huckabee ML, Doeltgen SH, Gumbley F, Robb M. The effect of effortful swallow on pharyngeal manometric measurements during saliva and water swallowing in healthy participants. Arch Phys Med Rehabil 2008; 89:822-8. [PMID: 18452727 DOI: 10.1016/j.apmr.2007.08.167] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 08/20/2007] [Accepted: 08/21/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effect of effortful swallow on pharyngeal manometric pressure measurements during saliva and water swallowing. DESIGN Comparative analysis of pharyngeal pressure generation under 2 bolus and 2 task conditions. SETTING Swallowing rehabilitation research laboratory. PARTICIPANTS Healthy participants (N=40), sex equally represented, with a mean age of 25.8 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Manometric peak and nadir amplitude and duration measures at 3 locations in the pharynx. RESULTS Significantly higher peak pressures were measured for saliva swallows compared with water swallows under both swallowing conditions at the proximal pharyngeal sensor only (P=.011). No significant differences were observed between the effortful versus noneffortful conditions at the proximal and midpharyngeal sensors; however, upper esophageal sphincter (UES) nadir pressures were significantly lower for effortful than noneffortful swallows (P=.034) with significantly lower pressure measurements in saliva effortful swallows (P=.008) compared with water effortful swallows. Saliva swallows resulted in significantly longer pressure durations than water swallows at the proximal (P=.003) and middle (P=.048) sensors. Pressure-generation duration was significantly longer in effortful versus noneffortful swallows for the middle sensor (P=.036) only. CONCLUSIONS The results indicate that the effect of effortful swallow on pharyngeal peak pressure measurement is not altered by bolus type (saliva vs water). However, this is not the case for nadir pressure measurements in the UES, which were significantly lower in effortful saliva swallows than in effortful water swallows.
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Affiliation(s)
- Ulrike Witte
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand.
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Bardan E, Kern M, Torrico S, Arndorfer RC, Massey BT, Shaker R. Radial asymmetry of the upper oesophageal sphincter pressure profile: fact or artefact. Neurogastroenterol Motil 2006; 18:418-24. [PMID: 16700720 DOI: 10.1111/j.1365-2982.2006.00773.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Radial asymmetry of the upper oesophageal sphincter high-pressure zone (UESHPZ) is an accepted notion based on manometric studies. Our aim was to evaluate the effect of the catheter diameter and configuration on the resting pressure profile of the UES. We studied 14 young (30 +/- 2 years) and 14 healthy elderly volunteers (77 +/- 2 years) using the station pull-through technique. We used a specially designed water perfused manometric assembly that incorporated a proximal round cross-section (4.8 mm) and a distal flat cross-section (4.8 x 1.2 mm). Anterior and posterior manometric sites on the round catheter measured significantly higher pressure values than did the sites oriented laterally at the same level (P < 0.001) in both young and elderly. In contrast, the flat-shaped catheter measured statistically indistinguishable pressures from all four orientations in both age groups. In both young and elderly the anterio-posterior, but not lateral pressures by the round catheter were significantly higher (P < 0.001) than those of the flat catheter. An exaggerated anteriorly and posteriorly oriented pressure may be recorded compared with lateral pressures depending on the diameter and non-conforming shape of the recording catheter with respect to the UES producing the appearance of radial asymmetry in the UESHPZ.
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Affiliation(s)
- E Bardan
- Chaim Sheba Medical Center, Tel Hashomer, Israel
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Abstract
The upper oesophageal sphincter (UOS) is a high-pressure zone comprising functional activity of three adjacent muscles together with cartilage and connective tissue. Its primary function is to allow food into the oesophagus and prevent air ingestion. However, it must also allow the reflux of material during belching or vomiting. Cricopharyngeus is the most important muscle with contributions from inferior pharyngeal constrictor and cervical oesophagus. Basal tone within the UOS is contributed to by all three muscles with asymmetry in the axial plane. Relaxation of the UOS occurs during swallowing as well as in sleep while UOS pressure rises with stress, slow oesophageal distension, intra-oesophageal acid infusion and pharyngeal stimulation with air or water. Many physiological characteristics have been attributed to UOS function following videofluoroscopic swallow examinations, manometry and electromyography but a range of normal values remains controversial and their utility uncertain. The result has been that pathological change is inconsistently characterized and management is instigated without a satisfactory evidence base. In this article, we review the anatomy, physiology and pathophysiology of the UOS along with the current opinions on investigation and treatment of UOS dysfunction.
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Affiliation(s)
- S Singh
- Department of GI Sciences, Hope Hospital, Manchester, UK
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