Propagation Curve and Velocity of Swallowing Pressure in Healthy Young Adults

Bionic design of the oral swallowing in vitro and its application in the dysphagia

Dysphagia, the swallowing disorder, is a common disease among the elders and stroke patients. Therefore, based on the bionic swallowing device (BSD) in vitro of similar human-tongue motion during swallowing, the development of functional food is necessary to improve the food swallowing quality of the deglutition disorders patients. In this study, the tongue motion was thoroughly investigated by extracting the characteristic data, and appropriate mechanisms in vitro were adopted to replicate the motion of the tongue swallowing according to the normal swallowing oropharyngeal data. The application of the BSD was also investigated at different swallowing grades (SGs). The study results indicated that the tongue motion consisted of tongue root point (TRP) and several tongue motor points (TMPs). The cam-link and push-rod mechanisms showed ellipse lines for TRP motion and straight lines for TMPs, respectively. Higher correlation coefficients between the tongue trajectories in the oropharyngeal data and simulated curves of the combined mechanism were observed. The average correlation coefficients between the tongue trajectories of patients at five SGs and those of the BSD were 0.87, proving its effectiveness and potential application. Furthermore, the corn-paste experiments of the BSD showed that dysphagia at five SGs could be a suitable choice for certain food concentrations. This will provide valuable insight into developing more functional foods in vitro for high deglutition disorders.

The effect of a chin-down maneuver after esophagectomy on oropharyngeal swallowing pressure measured using high-resolution manometry

OBJECTIVE

To elucidate the effects of a chin-down maneuver using high-resolution manometry (HRM) to measure pharyngeal swallowing pressure (SP) after esophagectomy.

METHODS

We evaluated 9 of 16 patients who underwent esophagectomy featuring gastric tube reconstruction and three-field lymph node dissection (3FL) in our Department of Gastroenterological Surgery from September 2015 to June 2016. We compared all parameters of the neutral and chin-down positions using HRM to measure the maximum SP at the velopharynx, meso-hypopharynx, and upper esophageal sphincter (UES) and the duration of lowered SP at the UES, the distance from nostrils to the boundary between hypopharynx and UES and to derive SP and SP propagation curves at various distances from the nostrils.

RESULTS

Compared to that at the neutral position, the maximum SP at the velopharynx was significantly lower in the chin-down position (p<0.05); however, SP at the meso-hypopharynx and UES did not differ significantly. The duration of lowered SP at the UES was significantly prolonged in the chin-down position and the distance from nostrils to the boundary between hypopharynx and UES was significantly shortened representing the elevation of the larynx, respectively (p<0.05, p<0.01). On the SP propagation curve for males, the times to SP peaks at 13, 16, 17, and 18cm from the nostrils were significantly prolonged (all p<0.05) in the chin-down position.

CONCLUSION

Chin-down positioning after esophagectomy/3FL may improve bolus passage by prolonging the duration of lowered SP at the UES, possibly by enhancing laryngeal elevation.

A systematic review of current methodology of high resolution pharyngeal manometry with and without impedance

PURPOSE

This systematic review appraises and summaries methodology documented in studies using high resolution pharyngeal manometry (HRM) with and without impedance technology (HRIM) in adult populations.

METHODS

Four electronic databases CINAHL, EMBASE, MEDLINE, and Cochrane Library were searched up to, and including March 2017. Studies reporting pharyngeal HRM/HRIM for swallowing and/or phonatory assessment, published in peer-reviewed journals in English, German, or Spanish were assessed for the inclusion criteria. Of the selected studies, methodological aspects of data acquisition and analysis were extracted. Publications were graded based on their level of evidence and quality of methodological aspects was assessed.

RESULTS

Sixty-two articles were identified eligible, from which 50 studies reported the use of HRM and 12 studies used HRIM. Of all included manuscripts, the majority utilized the ManoScan™ system (64.5%), a catheter diameter of 4.2 mm was most prevalently documented (30.6%). Most publications reported the application of topical anesthesia (53.2%). For data analysis in studies using HRM, software intrinsic to the recording system was reported most frequently (56%). A minority of the studies using HRM provided data about measurement reliability (10%). This is higher for studies using HRIM (50%).

CONCLUSIONS

Considerable methodological variability exists regarding data acquisition and analysis in published studies using HRM/HRIM. Lacking reports of methodology make study replications difficult and reduce the comparability across studies. More data regarding the impact of individual methodological aspects on study outcomes are further required for the development of methodological recommendations.