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McClain W, Luttrell J, Lambert E. Pediatric Dysphagia. Otolaryngol Clin North Am 2024; 57:531-540. [PMID: 38521722 DOI: 10.1016/j.otc.2024.02.010] [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] [Indexed: 03/25/2024]
Abstract
Pediatric dysphagia is a common condition encountered in clinical practice. We review the physiology and development of swallow, presentation, epidemiology, and etiology of dysphagia. Additionally, comorbidities, associated conditions, and medical management of dysphagia are discussed.
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Affiliation(s)
- Wade McClain
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, 101 Manning Drive Campus, Box #7070, Chapel Hill, NC 27514, USA.
| | - Jordan Luttrell
- Department of Otolaryngology, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 430, Memphis, TN 38163, USA
| | - Elton Lambert
- Department of Otolaryngology, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, MC:CC640, Houston, TX 77030, USA
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2
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Fogarty MJ. Dendritic morphology of motor neurons and interneurons within the compact, semicompact, and loose formations of the rat nucleus ambiguus. Front Cell Neurosci 2024; 18:1409974. [PMID: 38933178 PMCID: PMC11199410 DOI: 10.3389/fncel.2024.1409974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Motor neurons (MNs) within the nucleus ambiguus innervate the skeletal muscles of the larynx, pharynx, and oesophagus. These muscles are activated during vocalisation and swallowing and must be coordinated with several respiratory and other behaviours. Despite many studies evaluating the projections and orientation of MNs within the nucleus ambiguus, there is no quantitative information regarding the dendritic arbours of MNs residing in the compact, and semicompact/loose formations of the nucleus ambiguus.. Methods In female and male Fischer 344 rats, we evaluated MN number using Nissl staining, and MN and non-MN dendritic morphology using Golgi-Cox impregnation Brightfield imaging of transverse Nissl sections (15 μm) were taken to stereologically assess the number of nucleus ambiguus MNs within the compact and semicompact/loose formations. Pseudo-confocal imaging of Golgi-impregnated neurons within the nucleus ambiguus (sectioned transversely at 180 μm) was traced in 3D to determine dendritic arbourisation. Results We found a greater abundance of MNs within the compact than the semicompact/loose formations. Dendritic lengths, complexity, and convex hull surface areas were greatest in MNs of the semicompact/loose formation, with compact formation MNs being smaller. MNs from both regions were larger than non-MNs reconstructed within the nucleus ambiguus. Conclusion Adding HBLS to the diet could be a potentially effective strategy to improve horses' health.
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Affiliation(s)
- Matthew J. Fogarty
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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Kater KA, Seedat J. Weighing up the pros and cons of dysphagia triage in South Africa. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2023; 70:e1-e10. [PMID: 36861903 PMCID: PMC9982486 DOI: 10.4102/sajcd.v70i1.941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Early identification of dysphagia followed by intervention reduces, length of hospitalisation, degree of morbidity, hospital costs and risk of aspiration pneumonia. The emergency department offers an opportune space for triage. Triaging offers risk-based evaluation and early identification of dysphagia risk. A dysphagia triage protocol is not available in South Africa (SA). The current study aimed to address this gap. OBJECTIVES To establish the reliability and validity of a researcher-developed dysphagia triage checklist. METHOD A quantitative design was used. Sixteen doctors were recruited from a medical emergency unit at a public sector hospital in SA using non-probability sampling. Non-parametric statistics and correlation coefficients were used to determine the reliability, sensitivity and specificity of the checklist. RESULTS Poor reliability, high sensitivity and poor specificity of the developed dysphagia triage checklist was found. Importantly, the checklist was adequate in identifying patients as not being at risk for dysphagia. Completion time for dysphagia triage was 3 minutes. CONCLUSION The checklist was highly sensitive but not reliable or valid for use in identifying patients at risk for dysphagia.Contribution: The study provides a platform for further research and modification of the newly developed triage checklist, which is not recommended for use in its current form. The merits of dysphagia triage cannot be ignored. Once a valid and reliable tool is confirmed, the feasibility of implementation of dysphagia triage must be considered. Evidence to confirm that dysphagia triage can be conducted, when considering the contextual, economic, technical and logistic aspects of the context, is necessary.
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Affiliation(s)
- Kelly-Ann Kater
- Department of Speech Pathology, School of Human and Community Development, Faculty of Humanities, University of the Witwatersrand, Johannesburg.
| | - Jaishika Seedat
- Department of Speech Pathology, School of Human and Community Development, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
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Mayerl CJ, Gould FDH, Adjerid K, Edmonds C, German RZ. The Pathway from Anatomy and Physiology to Diagnosis: A Developmental Perspective on Swallowing and Dysphagia. Dysphagia 2023; 38:33-41. [PMID: 35441265 PMCID: PMC9579268 DOI: 10.1007/s00455-022-10449-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 04/04/2022] [Indexed: 01/29/2023]
Abstract
Dysphagia results from diverse and distinct etiologies. The pathway from anatomy and physiology to clinical diagnosis is complex and hierarchical. Our approach in this paper is to show the linkages from the underlying anatomy and physiology to the clinical presentation. In particular, the terms performance, function, behavior, and physiology are often used interchangeably, which we argue is an obstacle to clear discussion of mechanism of pathophysiology. We use examples from pediatric populations to highlight the importance of understanding anatomy and physiology to inform clinical practice. We first discuss the importance of understanding anatomy in the context of physiology and performance. We then use preterm infants and swallow-breathe coordination as examples to explicate the hierarchical nature of physiology and its impact on performance. We also highlight where the holes in our knowledge lie, with the ultimate endpoint of providing a framework that could enhance our ability to design interventions to help patients. Clarifying these terms, and the roles they play in the biology of dysphagia will help both the researchers studying the problems as well as the clinicians applying the results of those studies.
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Affiliation(s)
- C J Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - F D H Gould
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - K Adjerid
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - C Edmonds
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - R Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA.
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Pavšič K, Fabjan A, Zgonc V, Šurlan Popović K, Pretnar Oblak J, Bajrović FF. Clinical and Radiological Characteristics Associated with Respiratory Failure in Unilateral Lateral Medullary Infarction. J Stroke Cerebrovasc Dis 2021; 30:105947. [PMID: 34192618 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/01/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The prognosis for unilateral lateral medullary infarction (ULMI) is generally good but may be aggravated by respiratory failure with fatal outcome. Respiratory failure has been reported in patients with severe bulbar dysfunction and large rostral medullary lesions, but its associated factors have not been systematically studied. We aimed to assess clinical and radiological characteristics associated with respiratory failure in patients with pure acute ULMI. MATERIALS AND METHODS Seventy-one patients (median age 55 years, 59 males) with MRI-confirmed acute pure ULMI were studied retrospectively. Clinical characteristics were assessed and bulbar symptoms were scored using a scale developed for this study. MRI lesions were classified into 4 groups based on their vertical extent (localized/extensive) and the involvement of the open and/or closed medulla. Clinical characteristics, bulbar scores and MRI lesion characteristics were compared between patients with and without respiratory failure. RESULTS Respiratory failure occurred in 8(11%) patients. All patients with respiratory failure were male (p = 0.336), had extensive lesions involving the open medulla (p = 0.061), progression of bulbar symptoms (p=0.002) and aspiration pneumonia (p < 0.001). Peak bulbar score (OR, 7.9 [95% CI, 2.3-160.0]; p < 0.001) and older age (OR, 1.2 [95%CI, 1.0-1.6]; p=0.006) were independently associated with respiratory failure. CONCLUSIONS Extensive damage involving the open/rostral medulla, clinically presenting with severe bulbar dysfunction, in conjunction with factors such as aspiration pneumonia and older age appears to be crucial for the development of respiratory failure in pure ULMI. Further prospective studies are needed to identify other potential risk factors, pathophysiology, and effective preventive measures for respiratory failure in these patients.
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Affiliation(s)
- Katja Pavšič
- Department of Vascular Neurology and Intensive Therapy, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia.
| | - Andrej Fabjan
- Department of Vascular Neurology and Intensive Therapy, University Medical Centre Ljubljana, Slovenia; Institute of Physiology, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Vid Zgonc
- Department of Vascular Neurology and Intensive Therapy, University Medical Centre Ljubljana, Slovenia
| | | | - Janja Pretnar Oblak
- Department of Vascular Neurology and Intensive Therapy, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Fajko F Bajrović
- Department of Vascular Neurology and Intensive Therapy, University Medical Centre Ljubljana, Slovenia; Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Slovenia
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Chuchalin AG, Gusev EI, Martynov MY, Kim TG, Shogenova LV. [Pulmonary insufficiency in acute stroke: risk factors and mechanisms of development]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:7-16. [PMID: 32790970 DOI: 10.17116/jnevro20201200717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Various degrees of pulmonary insufficiency (PI) (PaO2 ≤60 mm Hg, SaO2 ≤90%) are diagnosed in most of patients with severe acute stroke (AS). Frequency and severity of PI positively correlates with the severity of AS. PI worsens patient's condition, prolongs the hospitalization period, and increases the probability of fatal outcome. Early clinical signs of PI may be undiagnosed due to the severity of stroke and thus not treated. The initiating pathogenic mechanism of PI is stress-related activation of sympathetic nervous system (SNS) and systemic immunosuppression. In severe stroke with mass effect, the rapid and significant increase in intracranial pressure may additionally activate the SNS. Risk factors of PI include older age, previous pulmonary disease, prolonged supine position, respiratory muscle dysfunction, apnea, and concomitant somatic diseases. Decompensation of somatic diseases leads to multiple stage reactions with facilitation of functional and morphologic changes in the pulmonary system, hypoxemia and hypoxia, promotes infectious complications and multiple organ failure and worsens neurological outcome. Diagnosis and treatment of PI in AS decreases mortality and improves rehabilitation prognosis.
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Affiliation(s)
- A G Chuchalin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E I Gusev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M Yu Martynov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - T G Kim
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - L V Shogenova
- Pirogov Russian National Research Medical University, Moscow, Russia
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Hasenstab‐Kenney KA, Bellodas Sanchez J, Prabhakar V, Lang IM, Shaker R, Jadcherla SR. Mechanisms of bradycardia in premature infants: Aerodigestive-cardiac regulatory-rhythm interactions. Physiol Rep 2020; 8:e14495. [PMID: 32643296 PMCID: PMC7343667 DOI: 10.14814/phy2.14495] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/26/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Eating difficulties coupled with cardiorespiratory spells delay acquisition of feeding milestones in convalescing neonates, and the mechanisms are unclear. Aims were to examine and compare the pharyngoesophageal-cardiorespiratory (PECR) response characteristics: (a) in control neonates and those with recurrent bradycardia spells; and (b) during pharyngeal stimulation when bradycardia occurs versus when no bradycardia occurs. METHODS Preterm infants (N = 40, 27 ± 3 weeks gestation), underwent concurrent pharyngoesophageal manometry, electrocardiography, respiratory inductance plethysmography, and nasal airflow thermistor to evaluate pharyngoesophageal motility, heart rate (HR), and respiration during graded abrupt pharyngeal sterile water stimuli. Infants with recurrent bradycardia (N = 28) and controls (N = 12) were evaluated at 38 (38-40) and 39 (38-40) weeks postmenstrual age, respectively. Comparisons were performed (a) between study and control groups; and (b) among HR responses of <80 BPM, 80-100 BPM, and >100 BPM. RESULTS Overall, characteristics of PECR responses in infants with a history of recurrent bradycardia (vs. controls) did not differ (p > .05). However, when pharyngeal stimulus induced severe bradycardia (<80 BPM): prolonged respiratory rhythm change, increased pharyngeal activity, increased esophageal dysmotility (as evidenced by prolonged esophageal inhibition and motor activity), and prolonged lower esophageal sphincter relaxation were noted (all p < .05). CONCLUSIONS In control infants and those with recurrent bradycardia, pharyngeal stimulation results in similar PECR response characteristics. However, when severe bradycardia occurs, PECR response characteristics are distinct. The mechanisms of severe bradycardia spells are related to abnormal prolongation of vagal inhibitory effects on cardiorespiratory rhythms in conjunction with prolonged esophageal inhibition and delays with terminal swallow.
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Affiliation(s)
- Kathryn A. Hasenstab‐Kenney
- Innovative Neonatal and Infant Feeding Disorders Research ProgramCenter for Perinatal ResearchThe Research Institute at Nationwide Children's HospitalColumbusOHUSA
| | - Jenny Bellodas Sanchez
- Innovative Neonatal and Infant Feeding Disorders Research ProgramCenter for Perinatal ResearchThe Research Institute at Nationwide Children's HospitalColumbusOHUSA
- Division of NeonatologyPediatric Gastroenterology and NutritionNationwide Children's HospitalColumbusOHUSA
| | - Varsha Prabhakar
- Innovative Neonatal and Infant Feeding Disorders Research ProgramCenter for Perinatal ResearchThe Research Institute at Nationwide Children's HospitalColumbusOHUSA
| | - Ivan M. Lang
- MCW Dysphagia InstituteDivision of Gastroenterology and HepatologyDepartment of MedicineMedical College of WisconsinMilwaukeeWIUSA
| | - Reza Shaker
- MCW Dysphagia InstituteDivision of Gastroenterology and HepatologyDepartment of MedicineMedical College of WisconsinMilwaukeeWIUSA
| | - Sudarshan R. Jadcherla
- Innovative Neonatal and Infant Feeding Disorders Research ProgramCenter for Perinatal ResearchThe Research Institute at Nationwide Children's HospitalColumbusOHUSA
- Division of NeonatologyPediatric Gastroenterology and NutritionNationwide Children's HospitalColumbusOHUSA
- Department of PediatricsThe Ohio State University College of MedicineColumbusOHUSA
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Kloepper A, Arnold J, Ruffolo A, Kinealy B, Haxton C, Nichols N, Takahashi K, Lever TE. An Experimental Swallow Evoked Potential Protocol to Investigate the Neural Substrates of Swallowing. OTO Open 2020; 4:2473974X20913542. [PMID: 32215355 PMCID: PMC7081471 DOI: 10.1177/2473974x20913542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/17/2019] [Indexed: 11/17/2022] Open
Abstract
Advancement in dysphagia intervention is hindered by our lack of understanding of the neural mechanisms of swallowing in health and disease. Evoking and understanding neural activity in response to normal and disordered swallowing is essential to bridge this knowledge gap. Building on sensory evoked potential methodology, we developed a minimally invasive approach to generate swallow evoked potentials (SwEPs) in response to repetitive swallowing induced by citric acid stimulation of the oropharynx in lightly anesthetized healthy adult rats. The SwEP waveform consisted of 8 replicable peaks within 10 milliseconds immediately preceding the onset of electromyographic swallowing activity. Methodology refinement is underway with healthy rats to establish normative SwEP waveform morphology before proceeding to models of advanced aging and age-related neurodegenerative diseases. Ultimately, we envision that this experimental protocol may unmask the pathologic neural substrates contributing to dysphagia to accelerate the discovery of targeted therapeutics.
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Affiliation(s)
- Ashley Kloepper
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Joseph Arnold
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Alexis Ruffolo
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Brian Kinealy
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Chandler Haxton
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Nicole Nichols
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Kazutaka Takahashi
- Research Computing Center, University of Chicago, Chicago, Illinois, USA
| | - Teresa E Lever
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA.,Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
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Chen H, Eckert DJ, van der Stelt PF, Guo J, Ge S, Emami E, Almeida FR, Huynh NT. Phenotypes of responders to mandibular advancement device therapy in obstructive sleep apnea patients: A systematic review and meta-analysis. Sleep Med Rev 2020; 49:101229. [DOI: 10.1016/j.smrv.2019.101229] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 12/12/2022]
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Cuellar ME, Harvey J. Predictive value of laryngeal adductor reflex testing in patients with dysphagia due to a cerebral vascular accident. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:593-601. [PMID: 30301381 DOI: 10.1080/17549507.2018.1512652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 06/27/2018] [Accepted: 07/19/2018] [Indexed: 06/08/2023]
Abstract
Purpose: To determine the relationship between air pulse vs. touch laryngeal adductor reflex (LAR) tests and the clinical sensory findings of fiberoptic endoscopic evaluations of swallowing.Method: A retrospective review was conducted for 43 patients with dysphagia due to stroke that underwent fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST). Each patient received LAR testing using air pulse or touch methodologies. Clinically, responsiveness to pharyngeal residue and responsiveness to penetration or aspiration were analysed.Result: The sensitivity, specificity, positive and negative predictive values for both LAR test groups indicate that LAR testing did not effectively predict sensory function during the clinical swallow evaluation. Across both LAR groups, specificity values were higher than sensitivity values. In fact, the specificity values for the light touch LAR test group were extremely high, but the negative predictive values did not support those findings. Sensitivity and positive predictive values were low for both groups.Conclusion: Although LAR testing provides valuable information regarding laryngeal sensory discrimination, the results of the current study suggest that a clinical evaluation of swallowing is critical for effectively assessing the way in which patients utilise sensory information during swallowing.
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Affiliation(s)
- Megan E Cuellar
- Speech-Language Pathology Program, Midwestern University, Downers Grove, IL, USA
| | - Jennine Harvey
- Communication Sciences and Disorders, Illinois State University, Normal, IL, USA
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Re GL, Vernuccio F, Di Vittorio ML, Scopelliti L, Di Piazza A, Terranova MC, Picone D, Tudisca C, Salerno S. Swallowing evaluation with videofluoroscopy in the paediatric population. ACTA ACUST UNITED AC 2019; 39:279-288. [PMID: 30933173 PMCID: PMC6843585 DOI: 10.14639/0392-100x-1942] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 04/15/2018] [Indexed: 11/23/2022]
Affiliation(s)
- G Lo Re
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - F Vernuccio
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - M L Di Vittorio
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - L Scopelliti
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - A Di Piazza
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - M C Terranova
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - D Picone
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - C Tudisca
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - S Salerno
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
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Langerman J, Doukas SG, Hasegawa H, Goodrich J, Lerner M, Sasaki C. In search of a longitudinal animal model of evoked swallow function. Laryngoscope Investig Otolaryngol 2018; 3:191-197. [PMID: 30062134 PMCID: PMC6057227 DOI: 10.1002/lio2.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/14/2018] [Accepted: 03/28/2018] [Indexed: 11/12/2022] Open
Abstract
Background A malfunction or impairment of swallow function can potentiate aspiration events and interfere with both quality of life and survival. Establishing an animal model for swallow research would provide a better understanding of its pathophysiology and would also allow for the development and validation of physiologically based clinical interventions to improve swallow function. Two requirements define the ideal model for longitudinal exploration: 1) identification of species similar to human in form and function; and 2) provision for reliable and reproducible evoked swallow under general anesthesia and one that would also support a longitudinal study design. Objective We hypothesize that an anesthetized porcine model under dexmedetomidine-based or ketamine-based anesthesia will support a reproducible and stable evoked swallow response. Methods Seven neutered male Yorkshire pigs were anesthetized using combinations of dexmedetomidine-based or ketamine-based anesthesia for induction and maintenance of anesthesia during the experimental portion of our study. Single stimulation of iSLN or vagus nerve, bilateral simultaneous single stimulation of iSLN or vagus nerve, and stimulus trains applied to afferent nerves were performed. Results None of the seven pigs demonstrated evoked swallow events, both during inhalational anesthesia (1.0 MAC) or during post-washout intravenous anesthesia (dexmedetomidine, ketamine/fentanyl or ketamine alone). Conclusion Our results support a high degree of organizational neurophysiologic complexity characterizing the swallow reflex and highlight the challenges and limitations of intraoperative study in survival models. Level of Evidence NA Laryngoscope, 2018.
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Affiliation(s)
- Jared Langerman
- Yale University School of Medicine New Haven Connecticut U.S.A
| | | | | | - James Goodrich
- Yale University School of Medicine New Haven Connecticut U.S.A
| | - Michael Lerner
- Yale University School of Medicine New Haven Connecticut U.S.A.,Albert Einstein College of Medicine Bronx New York U.S.A
| | - Clarence Sasaki
- Yale University School of Medicine New Haven Connecticut U.S.A
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Pedersen A, Sørensen CE, Proctor GB, Carpenter GH. Salivary functions in mastication, taste and textural perception, swallowing and initial digestion. Oral Dis 2018; 24:1399-1416. [PMID: 29645367 DOI: 10.1111/odi.12867] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 12/18/2022]
Abstract
Saliva exerts multiple functions in relation to the initial digestive processes taking place in the upper parts of the gastrointestinal tract. Ingestion of food and beverages, in turn, is a strong stimulus for secretion of saliva with a differential composition depending on the neuronal stimulation pattern. This review paper provides insight into the mechanisms by which saliva acts in relation to taste, mastication, bolus formation, enzymatic digestion and swallowing. Also, the protective functions of saliva including maintenance of dental and mucosal integrity will be discussed as they indirectly influence the digestive process. The final part of this study focuses on the implications of xerostomia and salivary gland dysfunction on gastrointestinal functions.
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Affiliation(s)
- Aml Pedersen
- Section 1, Oral Medicine, Oral Pathology & Clinical Oral Physiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - C E Sørensen
- Section of Oral Biochemistry, Cariology & Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - G B Proctor
- Mucosal & Salivary Biology Division, King's College London Dental Institute, Guy's & St Thomas' Hospitals, London, UK
| | - G H Carpenter
- Mucosal & Salivary Biology Division, King's College London Dental Institute, Guy's & St Thomas' Hospitals, London, UK
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14
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Kim HJ, Hong SN, Lee WH, Ahn JC, Cha MS, Rhee CS, Kim JW. Soft palate cephalometric changes with a mandibular advancement device may be associated with polysomnographic improvement in obstructive sleep apnea. Eur Arch Otorhinolaryngol 2018; 275:1811-1817. [PMID: 29796743 DOI: 10.1007/s00405-018-5007-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/18/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE It is unclear whether soft palate-associated changes in cephalometry associated with a mandibular advancement device (MAD) are independently associated with improvements in polysomnography (PSG) respiratory parameters in obstructive sleep apnea (OSA). METHODS This retrospective review aimed to identify the association between soft palate-associated changes in cephalometry and PSG changes after application of an MAD. Korean patients diagnosed with OSA who underwent cephalometry with or without an MAD were enrolled. All the patients were evaluated after undergoing full-night PSG twice: once with an MAD and once without. Cephalometric findings were measured using an image analyzer. RESULTS Mean apnea-hypopnea index significantly decreased with an MAD from 36.4/h to 14.7/h (p < 0.001). Retropalatal airway space significantly increased with an MAD from 6.6 to 7.3 mm (p = 0.013). Soft palate length also significantly decreased with an MAD from 43.6 to 42.3 mm (p = 0.02). Although these findings were shown by responders (patients with a reduction of apnea-hypopnea index by more than 50%), there were no significant changes in non-responders. However, retroglossal airway space did not significantly increase with an MAD even in responders. CONCLUSIONS Improvement of OSA with an MAD can be predicted with soft palate-associated upper airway changes shown in cephalometry.
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Affiliation(s)
- Hong Joong Kim
- Department of Otorhinolaryngology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, South Korea
| | - Seung-No Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Woo Hyun Lee
- Department of Otolaryngology, College of Medicine, Kangwon National University, Chuncheon, South Korea
| | - Jae-Cheul Ahn
- Department of Otorhinolaryngology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, South Korea
| | - Min-Sang Cha
- Department of Dentistry, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea.
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15
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DeLozier KR, Gould FDH, Ohlemacher J, Thexton AJ, German RZ. Impact of recurrent laryngeal nerve lesion on oropharyngeal muscle activity and sensorimotor integration in an infant pig model. J Appl Physiol (1985) 2018; 125:159-166. [PMID: 29648522 DOI: 10.1152/japplphysiol.00963.2017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The successful performance of a swallow requires dynamic integration between a wide range of sensory inputs and muscle activities to produce the coordinated kinematics of oropharyngeal structures. Damage to the recurrent laryngeal nerve (RLN) produces dysphagia in infants, with food or liquid entering the airway despite this nerve having minimal direct sensory or motor connections to the act of swallowing, apart from vocal fold closure. Previous results have demonstrated that a complete RLN lesion disrupts both performance and kinematics before initiation of the pharyngeal swallow in infants. We tested the hypothesis that a RLN lesion produces changes in the normal activity of oral floor, tongue, and infrahyoid muscles during a swallow. We recorded swallowing in our validated infant pig model, with synchronous high-speed imaging and fine-wire, chronic electromyography. We found changes in the timing, duration, and amplitude of the motor pattern in an array of muscles that are supplied by several different cranial and cervical nerves. Some of these changes in muscle activity are associated with the preparatory aspects of bolus aggregation or movement and so occur before the pharyngeal swallow. Taken with previous biomechanical results, these patterns suggest an intricate brain stem sensorimotor integration that occurs as part of a swallow. In particular, the execution of oral motor function is changed as a result of this simple lesion. NEW & NOTEWORTHY Damage to the recurrent laryngeal nerve compromises swallowing despite an absent or minimal contribution to either the motor or sensory aspects of this function. This study documents EMG changes, following RLN lesion, to non-RLN innervated muscles that are active during swallowing in an infant model. Some of these muscles fire before the pharyngeal swallow and are associated with the preparatory aspects of bolus aggregation and movement, suggesting important sensorimotor integration at a brain stem level.
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Affiliation(s)
- Katherine R DeLozier
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio
| | - Francois D H Gould
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio
| | - Jocelyn Ohlemacher
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio
| | - Allan J Thexton
- Department of Physiology, King's College , London , United Kingdom
| | - Rebecca Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio
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16
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Ghali MGZ. Phrenic motoneurons: output elements of a highly organized intraspinal network. J Neurophysiol 2018; 119:1057-1070. [DOI: 10.1152/jn.00705.2015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
pontomedullary respiratory network generates the respiratory pattern and relays it to bulbar and spinal respiratory motor outputs. The phrenic motor system controlling diaphragm contraction receives and processes descending commands to produce orderly, synchronous, and cycle-to-cycle-reproducible spatiotemporal firing. Multiple investigators have studied phrenic motoneurons (PhMNs) in an attempt to shed light on local mechanisms underlying phrenic pattern formation. I and colleagues (Marchenko V, Ghali MG, Rogers RF. Am J Physiol Regul Integr Comp Physiol 308: R916–R926, 2015.) recorded PhMNs in unanesthetized, decerebrate rats and related their activity to simultaneous phrenic nerve (PhN) activity by creating a time-frequency representation of PhMN-PhN power and coherence. On the basis of their temporal firing patterns and relationship to PhN activity, we categorized PhMNs into three classes, each of which emerges as a result of intrinsic biophysical and network properties and organizes the orderly contraction of diaphragm motor fibers. For example, early inspiratory diaphragmatic activation by the early coherent burst generated by high-frequency PhMNs may be necessary to prime it to overcome its initial inertia. We have also demonstrated the existence of a prominent role for local intraspinal inhibitory mechanisms in shaping phrenic pattern formation. The objective of this review is to relate and synthesize recent findings with those of previous studies with the aim of demonstrating that the phrenic nucleus is a region of active local processing, rather than a passive relay of descending inputs.
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Affiliation(s)
- Michael George Zaki Ghali
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania
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17
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Maturation Modulates Pharyngeal-Stimulus Provoked Pharyngeal and Respiratory Rhythms in Human Infants. Dysphagia 2017; 33:63-75. [PMID: 28828751 DOI: 10.1007/s00455-017-9833-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
Pharyngeal-provocation induced aerodigestive symptoms in infants remain an enigma. Sources of pharyngeal provocation can be anterograde as with feeding, and retrograde as in gastroesophageal reflux. We determined maturational and dose-response effects of targeted pharyngeal-stimulus on frequency, stability, and magnitude of pharyngeal and respiratory waveforms during multiple pharyngeal swallowing responses in preterm-born infants when they were of full-term postmenstrual age (PMA). Eighteen infants (11 male) were studied longitudinally at 39.8 ± 4.8 weeks PMA (time-1) and 44.1 ± 5.8 weeks PMA (time-2). Infants underwent concurrent pharyngo-esophageal manometry, respiratory inductance plethysmography, and nasal airflow thermistor methods to test sensory-motor interactions between the pharynx, esophagus, and airway. Linear mixed models were used and data presented as mean ± SEM or %. Overall, responses to 250 stimuli were analyzed. Of the multiple pharyngeal swallowing responses (n = 160), with maturation (a) deglutition apnea duration decreases (p < 0.01), (b) number of pharyngeal waveform peaks and duration decreases for initial responses (p < 0.01), and subsequent responses have lesser variation and greater stability (p < 0.01). With increment in stimulus volumes we noted (a) increased prevalence (%) of pharyngeal responses (p < 0.05), (b) increased number of pharyngeal peaks (p < 0.05), yet pharyngeal frequency (Hz), variability, and stability remain unaffected (p > 0.05), and (c) respiratory changes were unaffected (p > 0.05). Initial and subsequent pharyngeal responses and respiratory rhythm interactions become more distinct with maturation. Interval oromotor experiences and volume-dependent increase in adaptive responses may be contributory. These mechanisms may be important in modulating and restoring respiratory rhythm normalcy.
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18
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Coutier-Marie L, Ioan I, Bonabel C, Demoulin B, Leblanc AL, Debitu L, Schweitzer C, Marchal F, Demoulin-Alexikova S. Maturation of Airway Defensive Reflexes Is Related to Development of Feeding Behavior during Growth in Rabbits. Front Physiol 2017; 8:64. [PMID: 28228733 PMCID: PMC5296324 DOI: 10.3389/fphys.2017.00064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/24/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction: Cough and expiration reflex are major lower airway defense mechanisms that have not been studied throughout development in relation with the feeding behavior. Aim: To describe airway defense reflexes evoked by mechanical stimulation of the trachea in developing rabbit pups. Material and Methods: Sixty one pups were allocated to 3 groups according to their feeding behavior: suckling (n = 22), weanling (n = 21) and weaning (n = 18) group. The incidence and sensitivity of defense reflexes triggered by mechanical tracheal stimulation were studied in anesthetized and tracheotomized animals. Data are expressed as median (25th to 75th percentile). Results: The overall incidence of defensive responses (cough and/or expiration reflex) was found to be significantly higher in suckling [100% (50–100%); p = 0.01] and weanling [75% (40–100%); p = 0.05] animals when compared to weaning ones [37.5% (0–75%)]. However, cough motor pattern accounted for only 29% (0–62%) of all defensive responses in suckling rabbits and its frequency was significantly lower in this group when compared with weanling [100%(50–100%); p = 0.006] or weaning group [62%(50–100%), p = 0.05]. In other word the expiration reflex was the dominant response in suckling animals. Conclusion: Incidence and motor pattern of defensive responses were found to be linked to the pup feeding behavior and the expiration reflex was the major response triggered in suckling pups. The results suggest that this reflex is especially fitted to occur during the coordinated swallowing - breathing fast activities of sucking.
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Affiliation(s)
- Laurianne Coutier-Marie
- EA 3450DevAH - Laboratoire de Physiologie, Faculté de Médicine, Université de LorraineVandœuvre-lès-Nancy, France; Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'EnfantsVandœuvre-lès-Nancy, France; Service de Pneumologie, Hôpital Femme-Mère-Enfant, Hospices Civils de LyonLyon, France
| | - Iulia Ioan
- EA 3450DevAH - Laboratoire de Physiologie, Faculté de Médicine, Université de LorraineVandœuvre-lès-Nancy, France; Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'EnfantsVandœuvre-lès-Nancy, France
| | - Claude Bonabel
- Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants Vandœuvre-lès-Nancy, France
| | - Bruno Demoulin
- EA 3450DevAH - Laboratoire de Physiologie, Faculté de Médicine, Université de Lorraine Vandœuvre-lès-Nancy, France
| | - Anne-Laure Leblanc
- EA 3450DevAH - Laboratoire de Physiologie, Faculté de Médicine, Université de Lorraine Vandœuvre-lès-Nancy, France
| | - Ludivine Debitu
- EA 3450DevAH - Laboratoire de Physiologie, Faculté de Médicine, Université de Lorraine Vandœuvre-lès-Nancy, France
| | - Cyril Schweitzer
- EA 3450DevAH - Laboratoire de Physiologie, Faculté de Médicine, Université de LorraineVandœuvre-lès-Nancy, France; Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'EnfantsVandœuvre-lès-Nancy, France
| | - François Marchal
- Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants Vandœuvre-lès-Nancy, France
| | - Silvia Demoulin-Alexikova
- EA 3450DevAH - Laboratoire de Physiologie, Faculté de Médicine, Université de LorraineVandœuvre-lès-Nancy, France; Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'EnfantsVandœuvre-lès-Nancy, France
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19
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Lee W, Ahn YS, Lee S, Song BM, Hong S, Yoon JH. Occupational exposure to crystalline silica and gastric cancer: a systematic review and meta-analysis. Occup Environ Med 2016; 73:794-801. [PMID: 27621410 DOI: 10.1136/oemed-2016-103552] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 07/27/2016] [Indexed: 01/22/2023]
Abstract
Crystalline silica is a widely used industrial material that is readily available worldwide, and is one of the most common types of particulate mineral pollutants. It has been classified as a group 1 human carcinogen of the respiratory system; however, whether it is linked to gastric cancer remains uncertain. We conducted a systemic review and meta-analyses to search for evidence of the relationship between gastric cancer and occupational exposure to crystalline silica. We searched for articles on occupations involving silica exposure and gastric cancer studies up to December 2014. Pooled-risk estimates of the association between occupational crystalline silica exposure and risk of gastric cancer were calculated by a random effects model. Metaregression analyses of industry type and histological confirmation status, study design and industrial subgroup analyses were performed. 29 articles, including 9 case-control and 20 cohort studies, were analysed. The overall summary effects size was 1.25 (95% CI 1.18 to 1.34) for the association of occupational silica exposure with gastric cancer. Both heterogeneity and publication bias were partially attenuated after subgroup analyses. Heterogeneity of studies was attenuated after metaregression by industry. Higher overall effects were observed in the mining and foundry industries. We found a significant relationship between occupational crystalline silica exposure and gastric cancer. Our results were strengthened by various subgroup analyses and, considering the biological plausibility of our premise, further studies are required to better understand this association.
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Affiliation(s)
- Wanhyung Lee
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea Graduate School of Public Health, Yonsei University College of Medicine, Seoul, Korea Incheon Worker's Health Center, Korea
| | - Yeon-Soon Ahn
- Department of Occupational and Environmental Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Seunghyun Lee
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Bo Mi Song
- Graduate School of Public Health, Yonsei University College of Medicine, Seoul, Korea Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seri Hong
- Graduate School of Public Health, Yonsei University College of Medicine, Seoul, Korea Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Jin-Ha Yoon
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea Graduate School of Public Health, Yonsei University College of Medicine, Seoul, Korea Incheon Worker's Health Center, Korea Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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20
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Wang CM, Li HY, Lee LA, Shieh WY, Lin SW. Non-invasive Assessment of Swallowing and Respiration Coordination for the OSA Patient. Dysphagia 2016; 31:771-780. [PMID: 27515710 DOI: 10.1007/s00455-016-9740-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/28/2016] [Indexed: 12/14/2022]
Abstract
The objectives of this study are to investigate swallowing and its coordination with respiration in patients with obstructive sleep apnea (OSA). This is a prospective cohort study conducted in a tertiary referred Medical Center. A non-invasive method of assessing swallowing was used to detect the oropharyngeal swallowing parameters and the coordination with respiration during swallowing. The system used to assess swallowing detected: (1) movement of the larynx using a force-sensing resistor; (2) submental muscle activity using surface electromyography; and (3) coordination with respiration by measuring nasal airflow. Five sizes of water boluses (maximum 20 mL) were swallowed three times, and the data recorded and analyzed for each participant. Thirty-nine normal controls and 35 patients with OSA who fulfilled the inclusion criteria were recruited. The oropharyngeal swallowing parameters of the patients differed from the controls, including longer total excursion duration and shorter duration of submental muscles contraction. A longer swallowing respiratory pause (SRP), temporary coordination with respiration during swallowing, was demonstrated in the patients compared with the controls. The frequency of non-expiratory/expiratory pre- and postswallowing respiratory phase patterns of the patients was similar with the controls. There was significantly more piecemeal deglutition in OSA patients when clumping 10- and 20-mL water boluses swallowing together (p = 0.048). Oropharyngeal swallowing and coordination with respiration affected patients with OSA, and it could be detected using a non-invasive method. The results of this study may serve as a baseline for further research and help advance research methods in obstructive sleep apnea swallowing studies.
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Affiliation(s)
- Chin-Man Wang
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, No.5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305, Taiwan, ROC.
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, No.5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305, Taiwan, ROC.
| | - Li- Ang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, No.5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305, Taiwan, ROC
| | - Wann-Yun Shieh
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan City, 33305, Taiwan, ROC
| | - Shih-Wei Lin
- Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City, 33305, Taiwan, ROC
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21
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Abstract
AbstractMore than 35 years ago, Meltzoff and Moore (1977) published their famous article, “Imitation of facial and manual gestures by human neonates.” Their central conclusion, that neonates can imitate, was and continues to be controversial. Here, we focus on an often-neglected aspect of this debate, namely, neonatal spontaneous behaviors themselves. We present a case study of a paradigmatic orofacial “gesture,” namely tongue protrusion and retraction (TP/R). Against the background of new research on mammalian aerodigestive development, we ask: How does the human aerodigestive system develop, and what role does TP/R play in the neonate's emerging system of aerodigestion? We show that mammalian aerodigestion develops in two phases: (1) from the onset of isolated orofacial movementsin uteroto the postnatal mastery of suckling at 4 months after birth; and (2) thereafter, from preparation to the mastery of mastication and deglutition of solid foods. Like other orofacial stereotypies, TP/R emerges in the first phase and vanishes prior to the second. Based upon recent advances in activity-driven early neural development, we suggest a sequence of three developmental events in which TP/R might participate: the acquisition of tongue control, the integration of the central pattern generator (CPG) for TP/R with other aerodigestive CPGs, and the formation of connections within the cortical maps of S1 and M1. If correct, orofacial stereotypies are crucial to the maturation of aerodigestion in the neonatal period but also unlikely to co-occur with imitative behavior.
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22
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Sawan T, Harris ML, Kobylecki C, Baijens L, van Hooren M, Michou E. Lung Function Testing On and Off Dopaminergic Medication in Parkinson's Disease Patients With and Without Dysphagia. Mov Disord Clin Pract 2015; 3:146-150. [PMID: 30363501 DOI: 10.1002/mdc3.12251] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/17/2015] [Accepted: 08/02/2015] [Indexed: 11/10/2022] Open
Abstract
Background Swallowing function in individuals with Parkinson's disease (PD) can be negatively affected by dopaminergic medication with associated inhibition of brainstem reflexes. Three different "swallowing-safety" profiles of PD patients were previously observed, classified according to swallowing safety on and off levodopa. Methods Here, we investigated the effects of l-dopa on pulmonary function tests (PFTs) on 26 individuals with PD from the three different swallowing-safety profiles. PFTs results were compared to predicted values and direct comparisons between the groups with or without dysphagia were performed with nonparametric statistical tests (i.e., Kruskal-Wallis). Results A short (12-hour) withdrawal from l-dopa did not result in any significant changes in PFTs, and no differences on PFTs results were observed between the different dysphagic groups the on and off l-dopa state. No correlation was observed between the PFTs results with swallowing safety profiles of PD patients. Conclusions Although deglutition seems to be at least partially affected by dopaminergic repletion, dopaminergic mechanisms do not seem to be responsible for PD patients' performance in PFTs.
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Affiliation(s)
- Tareq Sawan
- Center of Gastrointestinal Sciences Institute of Inflammation and Repair Faculty of Medical and Life Sciences The University of Manchester Salford Royal NHS Foundation Trust Greater Manchester United Kingdom
| | - Mary Louise Harris
- Center of Gastrointestinal Sciences Institute of Inflammation and Repair Faculty of Medical and Life Sciences The University of Manchester Salford Royal NHS Foundation Trust Greater Manchester United Kingdom
| | - Christopher Kobylecki
- Department of Neurology Greater Manchester Neurosciences Center Salford Royal NHS Foundation Trust Salford United Kingdom.,Center for Clinical and Cognitive Neurosciences Institute for Brain, Behavior and Mental Health University of Manchester Manchester United Kingdom
| | - Laura Baijens
- Department of Otorhinolaryngology Head and Neck Surgery Maastricht University Medical Center Maastricht The Netherlands
| | - Michel van Hooren
- Department of Otorhinolaryngology Head and Neck Surgery Maastricht University Medical Center Maastricht The Netherlands
| | - Emilia Michou
- Center of Gastrointestinal Sciences Institute of Inflammation and Repair Faculty of Medical and Life Sciences The University of Manchester Salford Royal NHS Foundation Trust Greater Manchester United Kingdom
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23
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Wang CM, Shieh WY, Chen JY, Wu YR. Integrated non-invasive measurements reveal swallowing and respiration coordination recovery after unilateral stroke. Neurogastroenterol Motil 2015; 27:1398-408. [PMID: 26176581 DOI: 10.1111/nmo.12634] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/16/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Oropharyngeal dysphagia is common after a stroke. Understanding the physiology of swallowing and its coordination with respiration in stroke recovery is crucially important. METHODS A non-invasive swallowing assessment method was used to detect oropharyngeal swallowing and respiration coordination simultaneously during the swallowing process. This system detected movement of the larynx, submental muscle activity, and nasal airflow. Six different sizes of water boluses (maximum of 20 mL) were swallowed and assessed for each subject. KEY RESULTS We recruited 59 healthy participants and 38 first ever unilateral stroke patients completed baseline and follow-up assessments at 3, 6, and 9 months poststroke. The results showed that oropharyngeal swallowing parameters in unilateral stroke deviate from normal patterns. For respiration coordination, the unilateral stroke group had longer swallowing apnea duration but similar frequencies of pre- and postswallowing respiratory phase patterns compared with the healthy controls. The probability of piece-meal deglutition was higher in the stroke group than in the control group. Additionally, there were gradually decreasing piece-meal deglutition probabilities among the stroke patients at follow-up, and none differed statistically from those of the controls at 6 months poststroke. CONCLUSIONS & INFERENCES The non-invasive swallowing and respiration assessment method applied in this study detected the changes manifested in swallowing and respiration during the subacute phase of recovery in 6 months after a unilateral stroke. The study results serve as a baseline for further research and help advance dysphagia research methodologies. These assessments may be combined with bedside evaluations for clinical application.
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Affiliation(s)
- C-M Wang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - W-Y Shieh
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
| | - J-Y Chen
- Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Y-R Wu
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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24
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Oliveira LAMDP, Fontes LHDS, Cahali MB. Swallowing and pharyngo-esophageal manometry in obstructive sleep apnea. Braz J Otorhinolaryngol 2015; 81:294-300. [PMID: 25921934 PMCID: PMC9452234 DOI: 10.1016/j.bjorl.2015.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 06/29/2014] [Indexed: 02/06/2023] Open
Abstract
Introduction Objective Methods Results Conclusion
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Affiliation(s)
- Luciana Almeida Moreira da Paz Oliveira
- Department of Otorhinolaryngology, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil; Health Sciences, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil.
| | | | - Michel Burihan Cahali
- Department of Otorhinolaryngology, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil; Department of Otorhinolaryngology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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25
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Troche MS, Brandimore AE, Godoy J, Hegland KW. A framework for understanding shared substrates of airway protection. J Appl Oral Sci 2014; 22:251-60. [PMID: 25141195 PMCID: PMC4126819 DOI: 10.1590/1678-775720140132] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 05/06/2014] [Indexed: 02/01/2023] Open
Abstract
Deficits of airway protection can have deleterious effects to health and quality of
life. Effective airway protection requires a continuum of behaviors including
swallowing and cough. Swallowing prevents material from entering the airway and
coughing ejects endogenous material from the airway. There is significant overlap
between the control mechanisms for swallowing and cough. In this review we will
present the existing literature to support a novel framework for understanding shared
substrates of airway protection. This framework was originally adapted from Eccles'
model of cough28 (2009) by Hegland,
et al.42 (2012). It will serve to
provide a basis from which to develop future studies and test specific hypotheses
that advance our field and ultimately improve outcomes for people with airway
protective deficits.
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Affiliation(s)
- Michelle Shevon Troche
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | | | - Juliana Godoy
- Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Karen Wheeler Hegland
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
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26
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Ramakrishnan S, Arnett B, Murphy AD. Contextual modulation of a multifunctional central pattern generator. J Exp Biol 2014; 217:3935-44. [PMID: 25189372 DOI: 10.1242/jeb.086751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The multifunctional buccal central pattern generator in snails, which controls different oral behaviors, has been well characterized. In this work we propose a role for the group of about 40 electrotonically coupled buccal A cluster cells as a context-dependant switch for the buccal central pattern generator, modulating motor patterns that elicit different oral behaviors. We characterize these cells based on location and morphology, and provide evidence for their selective activation under two different stimuli - Listerine perfusion and intestinal nerve stimulation - triggering buccal motor patterns putatively underlying egestion and substrate cleaning. A new role for these electrotonically coupled buccal A cluster neurons is shown. They serve as a context-dependant switch that alters buccal motor patterns depending on input stimuli, thereby eliciting the appropriate behavioral response.
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Affiliation(s)
| | | | - A Don Murphy
- Department of Biological Sciences, University of Illinois, Chicago, IL-60607, USA
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27
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Wang CM, Chen JY, Chuang CC, Tseng WC, Wong AMK, Pei YC. Aging-related changes in swallowing, and in the coordination of swallowing and respiration determined by novel non-invasive measurement techniques. Geriatr Gerontol Int 2014; 15:736-44. [PMID: 25257507 DOI: 10.1111/ggi.12343] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2014] [Indexed: 12/23/2022]
Abstract
AIM Previous studies have shown that the process of swallowing changes with aging, a phenomenon known as presbyphagia. These subtle and subclinical age-related changes make older adults more vulnerable to dysphagia during disease insults. However, there are limited studies of the swallowing process in older adults, because measurements are typically invasive or require exposure to X-rays. In the present study, we used integrated non-invasive measurements to determine aging-related changes of swallowing, and in the coordination of swallowing and respiration for a population of healthy participants. METHODS The non-invasive system provided measurements of larynx movement with piezoelectric sensors, submental muscle activity with surface electromyography and respiration-swallowing coordination by measurement of nasal airflow. We recruited 112 healthy participants from the community, 35 in a young-age group (age 20-30 years), 38 in a middle-age group (age 31-50 years) and 39 in an old-age group (age 51-70 years). RESULTS The oropharyngeal swallowing parameters of the old-age group had delayed onset latency and longer swallowing apnea duration relative to the other groups, and these differences were greater for larger boluses. The middle- and old-age groups had less expiratory-expiratory respiratory phase pattern than the young-age group. The probability of piecemeal deglutition was highest in the old-age group and lowest in the young-age group. These results show that the phases of oropharyngeal swallowing and the coordination of swallowing with respiration gradually change with aging. CONCLUSIONS We used integrated non-invasive measurements to document age-related changes in swallowing, and in the coordination of swallowing and respiration in healthy adults.
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Affiliation(s)
- Chin-Man Wang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ji-Yih Chen
- Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chiung-Cheng Chuang
- Department of Biomedical Engineering, Chung Yuan Christian University, Chungli, Taiwan
| | - Wen-Chun Tseng
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Alice M K Wong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
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Matott M, Ciarlone G, Putnam R, Dean J. Normobaric hyperoxia (95% O2) stimulates CO2-sensitive and CO2-insensitive neurons in the caudal solitary complex of rat medullary tissue slices maintained in 40% O2. Neuroscience 2014; 270:98-122. [DOI: 10.1016/j.neuroscience.2014.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/09/2014] [Accepted: 03/10/2014] [Indexed: 12/13/2022]
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van den Engel-Hoek L, Erasmus CE, van Hulst KCM, Arvedson JC, de Groot IJM, de Swart BJM. Children with central and peripheral neurologic disorders have distinguishable patterns of dysphagia on videofluoroscopic swallow study. J Child Neurol 2014; 29:646-53. [PMID: 24022110 DOI: 10.1177/0883073813501871] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To determine whether findings on videofluoroscopic swallow studies reveal different patterns of dysphagia between children with central and peripheral neurologic disorders, a retrospective study of 118 videofluoroscopic swallow studies was completed. There were 3 groups: cerebral palsy with only spastic features (n = 53), cerebral palsy with dyskinetic features (n = 34), and neuromuscular disorders (myotonic dystrophy I, n = 5; spinal muscular atrophy I-II, n = 8; Duchenne muscular dystrophy, n = 8; other neuromuscular disorder, n = 10). Interpretation of the videofluoroscopic swallow studies was not blinded. The video fluoroscopic swallow study findings were compared dichotomously between the groups. Children with cerebral palsy demonstrated dysphagia in 1 or all phases of swallowing. In neuromuscular disorder, muscle weakness results in pharyngeal residue after swallow. The underlying swallowing problem in neuromuscular disorder is muscle weakness whereas that in cerebral palsy is more complex, having to do with abnormal control of swallowing. This study serves as a first exploration on specific characteristics of swallowing in different neurologic conditions and will help clinicians anticipate what they might expect.
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Affiliation(s)
- Lenie van den Engel-Hoek
- 1Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Medical Centre, Nijmegen, The Netherlands
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Browning KN. Modulation of gastrointestinal vagal neurocircuits by hyperglycemia. Front Neurosci 2013; 7:217. [PMID: 24324393 PMCID: PMC3840437 DOI: 10.3389/fnins.2013.00217] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/30/2013] [Indexed: 12/17/2022] Open
Abstract
Glucose sensing within autonomic neurocircuits is critical for the effective integration and regulation of a variety of physiological homeostatic functions including the co-ordination of vagally-mediated reflexes regulating gastrointestinal (GI) functions. Glucose regulates GI functions via actions at multiple sites of action, from modulating the activity of enteric neurons, endocrine cells, and glucose transporters within the intestine, to regulating the activity and responsiveness of the peripheral terminals, cell bodies and central terminals of vagal sensory neurons, to modifying both the activity and synaptic responsiveness of central brainstem neurons. Unsurprisingly, significant impairment in GI functions occurs in pathophysiological states where glucose levels are dysregulated, such as diabetes. A substantial obstacle to the development of new therapies to modify the disease, rather than treat the symptoms, are the gaps in our understanding of the mechanisms by which glucose modulates GI functions, particularly vagally-mediated responses and a more complete understanding of disease-related plasticity within these neurocircuits may open new avenues and targets for research.
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Affiliation(s)
- Kirsteen N Browning
- Department of Neural and Behavioral Sciences, Penn State College of Medicine Hershey, PA, USA
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Abstract
Many articles in this section of Comprehensive Physiology are concerned with the development and function of a central pattern generator (CPG) for the control of breathing in vertebrate animals. The action of the respiratory CPG is extensively modified by cortical and other descending influences as well as by feedback from peripheral sensory systems. The central nervous system also incorporates other CPGs, which orchestrate a wide variety of discrete and repetitive, voluntary and involuntary movements. The coordination of breathing with these other activities requires interaction and coordination between the respiratory CPG and those governing the nonrespiratory activities. Most of these interactions are complex and poorly understood. They seem to involve both conventional synaptic crosstalk between groups of neurons and fluid identity of neurons as belonging to one CPG or another: neurons that normally participate in breathing may be temporarily borrowed or hijacked by a competing or interrupting activity. This review explores the control of breathing as it is influenced by many activities that are generally considered to be nonrespiratory. The mechanistic detail varies greatly among topics, reflecting the wide variety of pertinent experiments.
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Affiliation(s)
- Donald Bartlett
- Department of Physiology & Neurobiology, Dartmouth Medical School, Lebanon, New Hampshire, USA.
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Tsujimura T, Udemgba C, Inoue M, Canning BJ. Laryngeal and tracheal afferent nerve stimulation evokes swallowing in anaesthetized guinea pigs. J Physiol 2013; 591:4667-79. [PMID: 23858010 DOI: 10.1113/jphysiol.2013.256024] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We describe swallowing reflexes evoked by laryngeal and tracheal vagal afferent nerve stimulation in anaesthetized guinea pigs. The swallowing reflexes evoked by laryngeal citric acid challenges were abolished by recurrent laryngeal nerve (RLN) transection and mimicked by electrical stimulation of the central cut ends of an RLN. By contrast, the number of swallows evoked by upper airway/pharyngeal distensions was not significantly reduced by RLN transection but they were virtually abolished by superior laryngeal nerve transection. Laryngeal citric acid-evoked swallowing was mimicked by laryngeal capsaicin challenges, implicating transient receptor potential vanilloid 1 (TRPV1)-expressing laryngeal afferent nerves arising from the jugular ganglia. The swallowing evoked by citric acid and capsaicin and evoked by electrical stimulation of either the tracheal or the laryngeal mucosa occurred at stimulation intensities that were typically subthreshold for evoking cough in these animals. Swallowing evoked by airway afferent nerve stimulation also desensitized at a much slower rate than cough. We speculate that swallowing is an essential component of airway protection from aspiration associated with laryngeal and tracheal afferent nerve activation.
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Affiliation(s)
- Takanori Tsujimura
- B. J. Canning: Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
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Nishino T. The swallowing reflex and its significance as an airway defensive reflex. Front Physiol 2013; 3:489. [PMID: 23316169 PMCID: PMC3539657 DOI: 10.3389/fphys.2012.00489] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 12/15/2012] [Indexed: 12/04/2022] Open
Abstract
Swallowing function, in humans, is very complex. Swallowing plays, not only an important role in food digestion, but also a major role in preventing the entrance of food and/or other materials into the lower respiratory tract. To achieve this, precise coordination is necessary between breathing and swallowing since the pharynx serves as a common pathway for both respiration and digestion. The swallowing reflex consists of afferent pathways, central integration, and efferent pathways. Any defect or disorder along reflex arc can cause a potential delay or impairment in swallow function. The swallowing reflex can be modulated not only by pathological factors but also by physiological factors. Among these, timing of swallows in relation to the phase of respiration may be the most important factor that determines the occurrence of pulmonary aspiration, since phases of inspiration and the expiration-inspiration transition are the most vulnerable for pulmonary aspiration.
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Lesion of the nucleus solitarius leads to impaired laryngeal sensation in bulbar palsy patients. J Stroke Cerebrovasc Dis 2011; 21:174-80. [PMID: 21775163 DOI: 10.1016/j.jstrokecerebrovasdis.2011.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/03/2011] [Accepted: 06/11/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In order to clarify the laryngeal sensation of bulbar palsy patients, we studied the relationship between laryngopharyngeal sensation and brainstem lesion in patients with dysphagia caused by bulbar palsy. METHODS Fifteen patients with lateral medullary infarction and dysphagia were included in this study. We performed laryngeal sensory test using the flexible laryngoscope and probes method previously developed by Yaguchi et al. The test sites included the right and left tip of the laryngeal surface of the epiglottis and bilateral arytenoid regions. Lesion sites were identified by magnetic resonance imaging and classified horizontally according to Kim's classification. We also used the anatomical atlas Cytoarchitecture of the Human Brain Stem to determine whether the lesions included the nucleus solitarius and nucleus ambiguus. RESULTS Eight cases had normal sensation and 7 cases had decreased sensation of the affected side of the epiglottis and arytenoid region. The lesions of decreased laryngeal sensation group were classified horizontally as large type or dorsal type and included the nucleus solitarius. Decreased laryngeal sensation was significantly correlated with lesions that included the nucleus solitarius (Fisher exact test; P = .026). CONCLUSIONS This study clarifies that patients with dysphagia caused by bulbar palsy may present with laryngeal sensory impairment of the affected side and laryngopharyngeal movement disorder. The important finding is that damage to both the nucleus solitarius and ambiguus cause dysphagia accompanied by decreased laryngeal sensation and that the lesions are relatively extensive and affect the middle level of the dorsal medulla.
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Browning KN, Wan S, Baptista V, Travagli RA. Vanilloid, purinergic, and CCK receptors activate glutamate release on single neurons of the nucleus tractus solitarius centralis. Am J Physiol Regul Integr Comp Physiol 2011; 301:R394-401. [PMID: 21543639 DOI: 10.1152/ajpregu.00054.2011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Baroreceptor inputs to nucleus of the tractus solitarius medialis (mNTS) neurons can be differentiated, among other features, by their response to vanilloid or purinergic agonists, active only on C- or A-fibers, respectively. A major aim of this study was to examine whether neurons of NTS centralis (cNTS), a subnucleus dominated by esophageal inputs, exhibit a similar dichotomy. Since it has been suggested that cholecystokinin (CCK), exerts its gastrointestinal (GI)-related effects via paracrine activation of vagal afferent C-fibers, we tested whether CCK-sensitive fibers impinging upon cNTS neurons are responsive to vanilloid but not purinergic agonists. Using whole cell patch-clamp recordings from cNTS, we recorded miniature excitatory postsynaptic currents (mEPSCs) to test the effects of the vanilloid agonist capsaicin, the purinergic agonist α,β-methylene-ATP (α,β-Met-ATP), and/or CCK-octapeptide (CCK-8s). α,β-Met-ATP, capsaicin; and CCK-8s increased EPSC frequency in 37, 71, and 46% of cNTS neurons, respectively. Approximately 30% of cNTS neurons were responsive to both CCK-8s and α,β-Met-ATP, to CCK-8s and capsaicin, or to α,β-Met-ATP and capsaicin, while 32% of neurons were responsive to all three agonists. All neurons responding to either α,β-Met-ATP or CCK-8s were also responsive to capsaicin. Perivagal capsaicin, which is supposed to induce a selective degeneration of C-fibers, decreased the number of cNTS neurons responding to capsaicin or CCK-8s but not those responding to α,β-Met-ATP. In summary, GI inputs to cNTS neurons cannot be distinguished on the basis of their selective responses to α,β-Met-ATP or capsaicin. Our data also indicate that CCK-8s increases glutamate release from purinergic and vanilloid responsive fibers impinging on cNTS neurons.
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Affiliation(s)
- Kirsteen N Browning
- Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, Pennsylvania 17033-0850, USA
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Steele CM, Miller AJ. Sensory input pathways and mechanisms in swallowing: a review. Dysphagia 2010; 25:323-33. [PMID: 20814803 PMCID: PMC2992653 DOI: 10.1007/s00455-010-9301-5] [Citation(s) in RCA: 178] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 08/14/2010] [Indexed: 01/21/2023]
Abstract
Over the past 20 years, research on the physiology of swallowing has confirmed that the oropharyngeal swallowing process can be modulated, both volitionally and in response to different sensory stimuli. In this review we identify what is known regarding the sensory pathways and mechanisms that are now thought to influence swallowing motor control and evoke its response. By synthesizing the current state of research evidence and knowledge, we identify continuing gaps in our knowledge of these mechanisms and pose questions for future research.
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Affiliation(s)
- Catriona M Steele
- Toronto Rehabilitation Institute, 550 University Avenue, #12030, Toronto, ON, M5G 2A2, Canada.
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Troche MS, Huebner I, Rosenbek JC, Okun MS, Sapienza CM. Respiratory-swallowing coordination and swallowing safety in patients with Parkinson's disease. Dysphagia 2010; 26:218-24. [PMID: 20623304 DOI: 10.1007/s00455-010-9289-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 06/22/2010] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to determine if individuals with Parkinson's disease (PD) demonstrate abnormal respiratory events when swallowing thin liquids. In addition, this study sought to define associations between respiratory events, swallowing apnea duration, and penetration-aspiration (P-A) scale scores. Thirty-nine individuals with PD were administered ten trials of a 5-ml thin liquid bolus. P-A scale score quantified the presence of penetration and aspiration during the swallowing of a 3-oz sequential bolus. Participants were divided into two groups based on swallowing safety judged during the 3-oz sequential swallowing: Group 1 = P-A ≤ 2; Group 2 = P-A ≥ 3. Swallows were examined using videofluoroscopy coupled with a nasal cannula to record respiratory signals during the event(s). Findings indicated that expiration was the predominant respiratory event before and after swallowing apnea. The data revealed no differences in our cohort versus the percentages of post-swallowing events reported in the literature for healthy adults. In addition, individuals with decreased swallowing safety, as measured by the P-A scale, were more likely to inspire after swallows and to have shorter swallowing apnea duration. Individuals who inspired before swallow also had longer swallowing apnea duration. The occurrence of inspiratory events after a swallow and the occurrence of shorter swallowing apnea durations may serve as important indicators during clinical swallowing assessments in patients at risk for penetration or aspiration with PD.
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Jadcherla SR, FRCPI, Gupta A, Wang M, Coley BD, Fernandez S, Shaker R. Definition and implications of novel pharyngo-glottal reflex in human infants using concurrent manometry ultrasonography. Am J Gastroenterol 2009; 104:2572-82. [PMID: 19603008 PMCID: PMC3791891 DOI: 10.1038/ajg.2009.411] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Glottal relationships during swallowing dominate the etiology of dysphagia. We investigated the pharyngo-glottal relationships during basal and adaptive swallowing. METHODS Temporal changes in glottal closure kinetics (frequency, response latency, and duration) with spontaneous and adaptive pharyngeal swallows were defined in 12 infants using concurrent pharyngoesophageal manometry and ultrasonography of the glottis. RESULTS Frequency, response latency, and duration of glottal closure with spontaneous swallows (n=53) were 100%, 0.27+/-0.1 s, and 1+/-0.22 s, respectively. The glottis adducted earlier (P<0.0001 vs. upper esophageal sphincter relaxation) within the same respiratory phase as swallow (P=0.03). With pharyngeal provocations (n=41), glottal adduction (pharyngo-glottal closure reflex (PGCR)) was noted first and then again with pharyngeal reflexive swallow (PRS). The frequency, response latency, and duration of glottal closure with PGCR were 100%, 0.56+/-0.13 s, and 0.52+/-0.1 s, respectively. Response latency to PRS was 3.24+/-0.33 s; the glottis adducted 97% within 0.36+/-0.08 s in the same respiratory phase (P=0.03), and remained adducted for 3.08+/-0.71 s. Glottal adduction was the quickest with spontaneous swallow (P=0.04 vs. PGCR), and the duration was the longest during PRS (P<0.005 vs. PGCR or spontaneous swallow). CONCLUSIONS Glottal adduction during basal or adaptive swallowing reflexes occurs in either respiratory phase, thus ensuring airway protection against pre-deglutitive or deglutitive aspiration. The independent existence and magnitude (duration of adduction) of PGCR suggests a hypervigilant state of the glottis in preventing aspiration during swallowing or during high gastroesophageal reflux events. Investigation of pharyngeal-glottal relationships with the use of noninvasive methods may be more acceptable across the age spectrum.
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Affiliation(s)
| | - FRCPI
- Sections of Neonatology, Pediatric Gastroenterology and Nutrition, Center for Perinatal Research, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Alankar Gupta
- Center for Perinatal Research, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Mansen Wang
- Center for Perinatal Research, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Brian D. Coley
- Departments of Pediatrics and Pediatric Radiology, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Soledad Fernandez
- Center for Biostatistics, Columbus Children’s Research Institute, The Ohio State University College of Medicine and Public Health, Columbus, Ohio, USA
| | - Reza Shaker
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Dysphagia Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Šutovská M, Fraňová S, Prisežnaková L, Nosáľová G, Togola A, Diallo D, Paulsen B, Capek P. Antitussive activity of polysaccharides isolated from the Malian medicinal plants. Int J Biol Macromol 2009; 44:236-9. [DOI: 10.1016/j.ijbiomac.2008.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Revised: 12/15/2008] [Accepted: 12/17/2008] [Indexed: 10/21/2022]
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Wheeler Hegland KM, Huber JE, Pitts T, Sapienza CM. Lung volume during swallowing: single bolus swallows in healthy young adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2009; 52:178-187. [PMID: 18723599 DOI: 10.1044/1092-4388(2008/07-0165)] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE This study examined the relationship between swallowing and lung volume initiation in healthy adults during single swallows of boluses differing in volume and consistency. Differences in lung volume according to respiratory phase surrounding the swallow were also assessed. METHOD Nine men and 11 women between the ages of 19 and 28 years served as study participants. Lung volume and respiratory phase data were recorded as each participant completed 5 trials each of 10-mL and 20-mL water boluses by cup, and thin and thick paste boluses by spoon, presented in randomized order. RESULTS Significant differences in lung volume at swallow initiation were found based on bolus consistency but not on bolus volume. No differences were found for lung volume initiation based on the respiratory phase surrounding the swallow or for the respiratory pattern based on bolus volume or consistency. CONCLUSION Findings of this study extend the existing knowledge base regarding the interaction of the swallow and respiratory systems by identifying targeted lung volumes at swallow initiation. In addition to other swallow-related biomechanical events and respiratory phase relationships surrounding a swallow, the lung volume at swallow initiation may be an important consideration when investigating swallow physiology and physiopathy.
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Development of swallowing and feeding: Prenatal through first year of life. ACTA ACUST UNITED AC 2008; 14:105-17. [DOI: 10.1002/ddrr.16] [Citation(s) in RCA: 246] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Jadcherla SR, Gupta A, Stoner E, Fernandez S, Shaker R. Pharyngeal swallowing: defining pharyngeal and upper esophageal sphincter relationships in human neonates. J Pediatr 2007; 151:597-603. [PMID: 18035137 PMCID: PMC2211414 DOI: 10.1016/j.jpeds.2007.04.042] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 04/05/2007] [Accepted: 04/19/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the hypothesis that the sensorimotor characteristics of the reflexes evoked on stimulation with air and water infusions differ by studying the effect of pharyngeal stimulation on pharyngeal-upper esophageal sphincter (UES) interactions in healthy neonates. STUDY DESIGN Pharyngo-UES-esophageal manometry was recorded in 10 neonates at 39 +/- 4 weeks postmenstrual age. Pharyngeal infusions (n = 155) of air (0.1 to 2.0 mL) and sterile water (0.1 to 0.5 mL) were given. Two types of reflexes were recognized: pharyngeal reflexive swallowing (PRS) and pharyngo-UES-contractile reflex (PUCR). Frequency occurrence, distribution of reflexes, threshold volume, response time, and stimulus-response relationship were evaluated. RESULTS The reflex response rates were 30% for air and 76% for water (P < .001). PRS was more frequent than PUCR with air and water (P < .05), even though the stimulation thresholds and response latencies were similar. Graded volumes of water but not air resulted in an increased frequency of PRS (P < .01). CONCLUSIONS PRS is more frequent than PUCR, and the 2 reflexes have distinctive characteristics in air and water stimuli. Both PRS and PUCR have implications for the evaluation of swallowing in infants.
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Affiliation(s)
- Sudarshan Rao Jadcherla
- Section of Neonatology, Columbus Children's Hospital and Department of Pediatrics, Ohio State University College of Medicine and Public Health, Columbus, OH 43205, USA.
| | - Alankar Gupta
- Section of Neonatology, Columbus Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205
| | - Erin Stoner
- Section of Neonatology, Columbus Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205
| | - Soledad Fernandez
- Center for Biostatistics at The Ohio State University College of Medicine and Public Health, Columbus Children’s Research Institute, 700 Children’s Drive, Columbus, OH 43205
| | - Reza Shaker
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, and Dysphagia Institute, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226
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Abstract
TEMA: o botulismo é uma doença neuroparalítica grave, de caráter agudo, afebril e causada pela ação de uma toxina produzida pelo Clostridium botulinum. Essa toxina se liga aos receptores da membrana do axônio dos neurônios motores, impedindo a liberação de acetilcolina na junção neuromuscular, o que causa paralisia flácida dos nervos cranianos e da musculatura esquelética, estruturas responsáveis pela adequada funcionalidade da deglutição nos indivíduos. OBJETIVO: apresentar o trabalho fonoaudiológico realizado junto a um paciente com quadro clínico de botulismo com queixa de disfagia. MÉTODO: paciente adulto, gênero masculino, com quadro clínico de botulismo, encaminhado para avaliação fonoaudiológica por apresentar dificuldades em deglutir saliva. Durante avaliação observou-se: alteração na mobilidade, tonicidade e sensibilidade dos órgãos do Sistema Miofuncional Orofacial (OMSs); redução dos movimentos laríngeos; estase de saliva em cavidade oral; ausência do reflexo de deglutição; ausência da função de deglutição. Foram realizadas nove sessões de fonoterapia, nas quais se abordou: estimulação dos OMSs - mobilidade, tonicidade e sensibilidade; estimulação dos reflexos orais e faríngeos; testes e treinos de deglutição com diferentes consistências alimentares e com auxilio de manobras de proteção e de limpeza de vias aéreas. RESULTADOS: melhora da mobilidade, tonicidade e sensibilidade dos OMSs; presença do reflexo de deglutição; melhora da elevação laríngea; restabelecimento da função de deglutição sem necessidade de assistência de qualquer profissional ou de manobras clínicas; qualidade vocal próxima aos parâmetros de normalidade (hipernasalidade e incoordenação pneumofonoarticulatória leves). Paciente recebeu alta fonoaudiológica e hospitalar, sendo indicado atendimento clínico para adequação e aperfeiçoamento dos OMSs. CONCLUSÃO: o trabalho fonoaudiológico mostrou-se eficiente no restabelecimento dos OMSs e da função da deglutição, possibilitando que o paciente restabelecesse a funcionalidade adequada de seu sistema miofuncional orofacial.
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Affiliation(s)
- Laura Davison Mangilli
- Programa de Pós-Graduação em Ciencias da Reabilitação, Faculdade de Medicina, Universidade de São Paulo, Brazil.
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Jobin V, Champagne V, Beauregard J, Charbonneau I, McFarland DH, Kimoff RJ. Swallowing function and upper airway sensation in obstructive sleep apnea. J Appl Physiol (1985) 2006; 102:1587-94. [PMID: 17185498 DOI: 10.1152/japplphysiol.00439.2006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to determine whether impaired upper airway (UA) mucosal sensation contributes to altered swallowing function in obstructive sleep apnea (OSA). We determined UA two-point discrimination threshold (2PDT) and vibratory sensation threshold (VST) in 15 men with untreated OSA and 9 nonapneic controls (CL). We then assessed swallowing responses to oropharyngeal fluid boluses delivered via a catheter. The threshold volume required to provoke swallowing and the mean latency to swallowing were determined, as was the phase of the respiratory cycle in which swallowing occurred [expressed as percentage of control cycle duration (%CCD)] and the extent of prolongation of the respiratory cycle after swallowing [inspiratory suppression time (IST)]. 2PDT and VST were significantly impaired in OSA patients compared with CL subjects. 2PDT was positively correlated with swallowing latency and threshold volume in CL subjects, but not in OSA patients. Threshold volume did not differ between the groups [median value = 0.1 ml (95% confidence interval = 0.1-0.2) for OSA and 0.15 ml (95% confidence interval = 0.1-0.16) for CL], whereas swallowing latency was shorter for OSA patients [3.3 (SD 0.7) vs. 3.9 (SD 0.8) s, P = 0.04]. %CCD and IST were similar for OSA patients and CL subjects. However, among OSA patients there was a significant inverse relation between VST and IST. These findings suggest that oropharyngeal sensory impairment in OSA is associated with an attenuation of inhibitory modulating inputs to reflex and central control of UA swallowing function.
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Affiliation(s)
- Vincent Jobin
- Respiratory Division and Sleep Laboratory, Meakins-Christie Laboratories, McGill University Health Centre, Quebec, Canada.
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Rüb U, Brunt ER, Petrasch-Parwez E, Schöls L, Theegarten D, Auburger G, Seidel K, Schultz C, Gierga K, Paulson H, van Broeckhoven C, Deller T, de Vos RAI. Degeneration of ingestion-related brainstem nuclei in spinocerebellar ataxia type 2, 3, 6 and 7. Neuropathol Appl Neurobiol 2006; 32:635-49. [PMID: 17083478 DOI: 10.1111/j.1365-2990.2006.00772.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Dysphagia, which can lead to nutritional deficiencies, weight loss and dehydration, represents a risk factor for aspiration pneumonia. Although clinical studies have reported the occurrence of dysphagia in patients with spinocerebellar ataxia type 2 (SCA2), type 3 (SCA3), type 6 (SCA6) and type 7 (SCA7), there are neither detailed clinical records concerning the kind of ingestive malfunctions which contribute to dysphagia nor systematic pathoanatomical studies of brainstem regions involved in the ingestive process. In the present study we performed a systematic post mortem study on thick serial tissue sections through the ingestion-related brainstem nuclei of 12 dysphagic patients who suffered from clinically diagnosed and genetically confirmed spinocerebellar ataxias assigned to the CAG-repeat or polyglutamine diseases (two SCA2, seven SCA3, one SCA6 and two SCA7 patients) and evaluated their medical records. Upon pathoanatomical examination in all of the SCA2, SCA3, SCA6 and SCA7 patients, a widespread neurodegeneration of the brainstem nuclei involved in the ingestive process was found. The clinical records revealed that all of the SCA patients were diagnosed with progressive dysphagia and showed dysfunctions detrimental to the preparatory phase of the ingestive process, as well as the lingual, pharyngeal and oesophageal phases of swallowing. The vast majority of the SCA patients suffered from aspiration pneumonia, which was the most frequent cause of death in our sample. The findings of the present study suggest (i) that dysphagia in SCA2, SCA3, SCA6 and SCA7 patients may be associated with widespread neurodegeneration of ingestion-related brainstem nuclei; (ii) that dysphagic SCA2, SCA3, SCA6 and SCA7 patients may suffer from dysfunctions detrimental to all phases of the ingestive process; and (iii) that rehabilitative swallow therapy which takes specific functional consequences of the underlying brainstem lesions into account might be helpful in preventing aspiration pneumonia, weight loss and dehydration in SCA2, SCA3, SCA6 and SCA7 patients.
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Affiliation(s)
- U Rüb
- Department of Clinical Neuroanatomy, J W Goethe-University, Frankfurt/Main, Germany.
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Abstract
The pharyngoesophageal segment of the foregut has an important function in steering clear of luminal contents from the airway, across the age spectrum from a premature neonate to an aging adult. This complex neuromuscular interaction between the esophagus and the airway is maintained by a variety of mechanisms mediated by the parasympathetic and sympathetic afferent and efferent outflows involving the myenteric plexus, glossopharyngeal and vagus cranial nerves, phrenic nerve, and brainstem nuclei. The esophageal provocation during gastroesophageal reflux events results in esophageal distention, followed by responses in the esophagus, the airway, or both. Studies involving esophageal provocation in human adults and animal models are beginning to illuminate the pathogenetic mechanisms associated with aerodigestive tract disease. However, studies pertinent to this topic in infants or children have been lacking. In this paper, we review recent advances concerning the motor responses of the esophagus and the airway ensuing upon esophageal distention. Recent advances in methods to evaluate aerodigestive responses in infants that have been validated are discussed.
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Affiliation(s)
- Sudarshan R Jadcherla
- Section of Neonatology and Pediatric Gastroenterology and Nutrition, Columbus Children's Hospital, OH 43205, USA.
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Trotter RN, Stornetta RL, Guyenet PG, Roberts MR. Transneuronal mapping of the CNS network controlling sympathetic outflow to the rat thymus. Auton Neurosci 2006; 131:9-20. [PMID: 16843070 DOI: 10.1016/j.autneu.2006.06.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 05/30/2006] [Accepted: 06/02/2006] [Indexed: 11/24/2022]
Abstract
The thymus is a primary immune organ that is essential for the development of functional T cells. The thymus receives sympathetic innervation, and thymocytes and thymic epithelial cells express functional adrenergic receptors. In this study, we employed retrograde, transneuronal virus tracing to identify the CNS cell groups that regulate sympathetic outflow to the thymus. Pseudorabies virus (PRV) was injected into the thymus, and the pattern of PRV infection in sympathetic regulatory centers of the CNS was determined at 72 and 120 h post-inoculation. PRV infection within the CNS first appeared within the spinal cord at 72 h post-inoculation and was confined to neurons within the intermediolateral cell column at levels T1-T7. At 120 h post-inoculation infection had spread within the spinal cord to include the central autonomic nucleus, intercalated cell nucleus and light infection within the cells of the lateral funiculus. Within the brain, PRV positive cells were found within nuclei of the medulla oblongata, pons and hypothalamus. Infection in the hypothalamus was observed within the arcuate nucleus, dorsal, lateral, and posterior hypothalamus and in all parvicellular subdivisions of the paraventricular hypothalamic nucleus. None of the infected animals exhibited labeling of the dorsal motor nucleus of the vagus. In summary, this study provides the first anatomic map of CNS neurons involved in control of sympathetic outflow to the thymus.
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Affiliation(s)
- R Nicholas Trotter
- Department of Microbiology, University of Virginia, PO Box 800734, Charlottesville, VA 22908, USA
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Neuhuber WL, Raab M, Berthoud HR, Wörl J. Innervation of the mammalian esophagus. ADVANCES IN ANATOMY EMBRYOLOGY AND CELL BIOLOGY 2006. [PMID: 16573241 DOI: 10.1007/978-3-540-32948-0_1] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Understanding the innervation of the esophagus is a prerequisite for successful treatment of a variety of disorders, e.g., dysphagia, achalasia, gastroesophageal reflux disease (GERD) and non-cardiac chest pain. Although, at first glance, functions of the esophagus are relatively simple, their neuronal control is considerably complex. Vagal motor neurons of the nucleus ambiguus and preganglionic neurons of the dorsal motor nucleus innervate striated and smooth muscle, respectively. Myenteric neurons represent the interface between the dorsal motor nucleus and smooth muscle but they are also involved in striated muscle innervation. Intraganglionic laminar endings (IGLEs) represent mechanosensory vagal afferent terminals. They also establish intricate connections with enteric neurons. Afferent information is implemented by the swallowing central pattern generator in the brainstem, which generates and coordinates deglutitive activity in both striated and smooth esophageal muscle and orchestrates esophageal sphincters as well as gastric adaptive relaxation. Disturbed excitation/inhibition balance in the lower esophageal sphincter results in motility disorders, e.g., achalasia and GERD. Loss of mechanosensory afferents disrupts adaptation of deglutitive motor programs to bolus variables, eventually leading to megaesophagus. Both spinal and vagal afferents appear to contribute to painful sensations, e.g., non-cardiac chest pain. Extrinsic and intrinsic neurons may be involved in intramural reflexes using acetylcholine, nitric oxide, substance P, CGRP and glutamate as main transmitters. In addition, other molecules, e.g., ATP, GABA and probably also inflammatory cytokines, may modulate these neuronal functions.
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Gourcerol G, Marie JP, Verin E. Glottis constriction response in healthy subjects. Respir Physiol Neurobiol 2005; 148:303-8. [PMID: 16143286 DOI: 10.1016/j.resp.2005.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Revised: 02/09/2005] [Accepted: 02/10/2005] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to evaluate the glottis constriction response induced by a sudden and involuntary increase in gastric and oesophageal pressures by Tll-Ll intervertebral magnetic stimulation of the abdominal muscle roots in nine healthy subjects. Twitch flow, twitch gastric, and oesophageal pressures were measured after abdominal muscle root stimulation, which allowed pharyngo-laryngeal muscle activation to be characterized. Pharyngeal endoscopies were performed on five subjects to assess vocal cord movements. All stimulations induced positive gastric and oesophageal pressures and expiratory flow, which increased with stimulation intensity (flow: R=0.32; p<0.0001; oesophageal pressure: R=0.26; p=0.001; gastric pressure: R=0.37; p<0.0001). Twitch gastric pressure and twitch oesophageal pressure were negatively correlated with twitch flow (respectively, R=-0.183, p<0.05; R=-0.35, p<0.0001). Upper airway resistance was higher at peak oesophageal pressure than at peak flow (p<0.001). Peak twitch gastric and twitch oesophageal pressure latencies were similar (133+/-4ms and 122+/-4ms) but longer than peak twitch flow and EMG latencies (62+/-2ms and 73+/-4ms, p<0.0001). Glottis constriction following magnetic abdominal muscle root stimulation was seen in all subjects during endoscopy, with a latency estimated at between 80 and 100ms. This method could be a new, simple tool for assessing the upper airway constriction protective reflex.
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Affiliation(s)
- Guillaume Gourcerol
- Service de Physiologie Digestive, Urinaire, Respiratoire et Sportive, Hôpital Charles Nicolle, CHU de Rouen, 1 rue de Germont, 76031 Rouen Cedex, France
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Cheng G, Zhou X, Qu J, Ashwell KWS, Paxinos G. Central vagal sensory and motor connections: human embryonic and fetal development. Auton Neurosci 2004; 114:83-96. [PMID: 15331048 DOI: 10.1016/j.autneu.2004.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Revised: 05/20/2004] [Accepted: 06/22/2004] [Indexed: 10/26/2022]
Abstract
The embryonic and fetal development of the nuclear components and pathways of vagal sensorimotor circuits in the human has been studied using Nissl staining and carbocyanine dye tracing techniques. Eight fetal brains ranging from 8 to 28 weeks of development had DiI (1,1'-dioctadecyl-3,3,3',3' tetramethylindocarbocyanine perchlorate) inserted into either the thoracic vagus nerve at the level of the sternal angle (two specimens of 8 and 9 weeks of gestation) or into vagal rootlets at the surface of the medulla (at all other ages), while a further five were used for study of cytoarchitectural development. The first central labeling resulting from peripheral application of DiI to the thoracic vagus nerve was seen at 8 weeks. By 9 weeks, labeled bipolar cells at the ventricular surface around the sulcus limitans (sl) were seen after DiI application to the thoracic vagus nerve. Subnuclear organization as revealed by both Nissl staining and carbocyanine dye tracing was found to be advanced at a relatively early fetal age, with afferent segregation in the medial Sol apparent at 13 weeks and subnuclear organization of efferent magnocellular divisions of dorsal motor nucleus of vagus nerve noticeable at the same stage. The results of the present study also confirm that vagal afferents are distributed to the dorsomedial subnuclei of the human nucleus of the solitary tract, with particular concentrations of afferent axons in the gelatinosus subnucleus. These vagal afferents appeared to have a restricted zone of termination from quite early in development (13 weeks) suggesting that there is no initial exuberance in the termination field of vagal afferents in the developing human nucleus of the solitary tract. On the other hand, the first suggestion of afferents invading 10N from the medial Sol was not seen until 20 weeks and was not well developed until 24 weeks, suggesting that direct monosynaptic connections between the sensory and effector components of the vagal sensorimotor complex do not develop until this age.
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Affiliation(s)
- Gang Cheng
- Prince of Wales Medical Research Institute, Barker St. Randwick 2031 NSW, Australia.
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