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Cortez-Aoyagi M, Gufstason E, Murphy A, van Mersbergen M. A Measure of Swallow Effort Using the Borg Category Ratio 10 Perceived Exertion Scale. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2846-2857. [PMID: 37713539 DOI: 10.1044/2023_ajslp-23-00090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
PURPOSE With the emphasis on patient-centered care, tools to adequately measure the experience of swallowing are an important part of clinical care. Swallowing effort is one such experience. However, few measurement tools capture swallowing effort in the moment of swallowing to quantify effort. The Borg Category Ratio 10 Perceived Exertion Scale (Borg CR 10), designed to track effort in a variety of tasks from lifting, breathing, and running, appears to be a likely candidate to measure swallowing effort in the moment of swallowing. METHOD In a quasi-random design, 32 healthy individuals, ages 40-80 years (average age: 63 years), consumed seven bolus consistencies in both small and large quantities, three times. Following each individual swallow, they rated the amount of effort it took to swallow each bolus using an adapted Borg CR 10 for swallowing effort. RESULTS Results showed significantly greater reports of swallowing effort on the Borg CR 10 for more adhesive consistencies, larger quantities, and increased number of swallows. CONCLUSION Results suggest that the Borg CR 10 is a reasonable measurement tool to capture patient-perceived effort in swallowing.
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Affiliation(s)
| | - Erin Gufstason
- Northern Illinois University, DeKalb
- UW Health in Northern Illinois, Rockford
| | - Amanda Murphy
- Northern Illinois University, DeKalb
- Chicago Public Schools, IL
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Pitts T, Iceman KE. Deglutition and the Regulation of the Swallow Motor Pattern. Physiology (Bethesda) 2023; 38:0. [PMID: 35998250 PMCID: PMC9707372 DOI: 10.1152/physiol.00005.2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 11/22/2022] Open
Abstract
Despite centuries of investigation, questions and controversies remain regarding the fundamental genesis and motor pattern of swallow. Two significant topics include inspiratory muscle activity during swallow (Schluckatmung, i.e., "swallow-breath") and anatomical boundaries of the swallow pattern generator. We discuss the long history of reports regarding the presence or absence of Schluckatmung and the possible advantages of and neural basis for such activity, leading to current theories and novel experimental directions.
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Affiliation(s)
- Teresa Pitts
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
| | - Kimberly E Iceman
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
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Behavioral Interventions Targeting Base of Tongue to Posterior Pharyngeal Wall Approximation: A Scoping Review. Dysphagia 2022; 38:768-784. [PMID: 36163399 PMCID: PMC10182935 DOI: 10.1007/s00455-022-10519-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
Pharyngeal pressure generated by approximation of the base of tongue to the posterior pharyngeal wall (BOT-PPW approximation) is critical for efficient pharyngeal bolus passage and is a frequent goal of dysphagia management. This scoping review evaluated behavioral interventions available to improve BOT-PPW approximation. We searched MEDLINE, CINAHL, Ovid Emcare, Web of Science, SCOPUS, and ProQuest for studies that met the following criteria: (i) behavioral interventions targeting BOT-PPW approximation, which (ii) were assessed using BOT-PPW-specific outcome measures, and (iiia) performed over a period of time (Review Part 1) or (iiib) studied immediate effects (Review Part 2). Study quality was rated using the GRADE framework. Data were extracted and synthesized into dominant themes. Of the 150 studies originally identified, three examined long-term effects (two single cases studies of individuals with dysphagia, and a third study evaluating effortful swallowing in healthy individuals). BOT-PPW approximation only increased in the two single case studies. Twenty-one studies evaluating immediate effects were categorized as follows: (1) effortful swallowing, (2) Mendelsohn maneuver, (3) tongue-hold maneuver, (4) super supraglottic swallowing maneuver, and (5) non-swallowing exercises. Across all studies, varying levels of success in increasing BOT-PPW approximation were reported. Four of 21 immediate effects studies evaluated patients with demonstrated swallowing impairment, whereas 17 studies evaluated healthy adults. Quality assessment revealed low strength of the existing evidence base. The evidence base for rehabilitative interventions targeting BOT-PPW approximation is severely limited and translation is hindered by small sample sizes and methodological limitations. Further clinical research is warranted.
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Pitts T, Iceman KE, Huff A, Musselwhite MN, Frazure ML, Young KC, Greene CL, Howland DR. Laryngeal and swallow dysregulation following acute cervical spinal cord injury. J Neurophysiol 2022; 128:405-417. [PMID: 35830612 PMCID: PMC9359645 DOI: 10.1152/jn.00469.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Laryngeal function is vital to airway protection. While swallow is mediated by the brainstem, mechanisms underlying increased risk of dysphagia after cervical spinal cord injury (SCI) are unknown. We hypothesized that loss of descending phrenic drive affects swallow and breathing differently, and loss of ascending spinal afferent information alters swallow regulation. We recorded electromyograms from upper airway and chest wall muscles in freely breathing pentobarbital-anesthetized cats and rats. Inspiratory laryngeal activity increased ~two-fold following C2 lateral-hemisection. Ipsilateral to the injury, crural diaphragm EMG amplitude was reduced during breathing (62 ± 25% change post-injury), but no animal had complete termination of activity; 75% of animals increased contralateral diaphragm recruitment, but this did not reach significance. During swallow, laryngeal adductor and pharyngeal constrictor muscles increased activity, and diaphragm activity was bilaterally suppressed. This was unexpected because of the ipsilateral-specific response during breathing. Swallow-breathing coordination was also disrupted and more swallows occurred during early expiration. Finally, to determine if the chest wall is a major source of feedback for laryngeal regulation, we performed T1 total transections in rats. As in the C2 lateral-hemisection, inspiratory laryngeal recruitment was the first feature noted. In contrast to the C2 lateral-hemisection, diaphragmatic drive increased after T1 transection. Overall, we found that SCI alters laryngeal drive during swallow and breathing, and reduced swallow-related diaphragm activity. Our results show behavior-specific effects, suggesting SCI affects swallow more than breathing, and emphasizes the need for additional studies on the effects of ascending afferents from the spinal cord on laryngeal function.
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Affiliation(s)
- Teresa Pitts
- Kentucky Spinal Cord Injury Center, Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Kimberly E Iceman
- Kentucky Spinal Cord Injury Center, Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Alyssa Huff
- Center for Integrative Brain Research, Seattle Children's Hospital, Seattle, WA, United States
| | - Matthew Nicholas Musselwhite
- Kentucky Spinal Cord Injury Center, Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Michael L Frazure
- Kentucky Spinal Cord Injury Center, Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Kellyanna C Young
- Kentucky Spinal Cord Injury Center, Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Clinton L Greene
- Kentucky Spinal Cord Injury Center, Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Dena Ruth Howland
- Kentucky Spinal Cord Injury Center, Department of Neurological Surgery, University of Louisville, Louisville, KY, United States.,Research Service, Robley Rex VA Medical Center, Louisville, KY, United States
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Schar MS, Omari TI, Woods CM, Cock C, Doeltgen SH, Chai-Coetzer CL, Eckert DJ, Athanasiadis T, Ooi EH. Swallowing biomechanics before and following multi-level upper airway surgery for obstructive sleep apnea. J Clin Sleep Med 2022; 18:1167-1176. [PMID: 34913869 PMCID: PMC8974379 DOI: 10.5664/jcsm.9824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The effect of contemporary multi-level upper airway surgery for obstructive sleep apnea on swallowing is unclear. This study assessed the biomechanical swallowing function in participants with obstructive sleep apnea pre- and post-modified uvulopalatopharyngoplasty and coblation channeling of the tongue. METHODS In this prospective, longitudinal study, adults diagnosed with moderate-severe obstructive sleep apnea who underwent modified uvulopalatopharyngoplasty and coblation channeling of the tongue surgery had swallowing biomechanics assessed using high-resolution pharyngeal manometry and analyzed with swallowgateway.com. Symptomatic swallowing difficulty was evaluated using the Sydney Swallow Questionnaire (≥ 234). General linear mixed-model analysis was conducted to evaluate the difference pre- and post-modified uvulopalatopharyngoplasty and coblation channeling of the tongue. Data are presented as mean [95% confidence intervals]. RESULTS High-resolution pharyngeal manometry assessments were conducted in 10 participants (7 men; median age 50 [interquartile range 36-65]) preoperatively and repeated postoperatively at 9 months [interquartile range 6-13]. Self-reported dysphagia was unchanged following surgery (Sydney Swallow Questionnaire =149 [53, 447] to 168 [54, 247]; P = .093). High-resolution pharyngeal manometry outcomes indicated reduced mesopharyngeal pressures (148 [135, 161] to 124 [112, 137] mm Hg s cm; P = .011), reduced hypopharyngeal pressures (113 [101, 125] to 93 [84, 102] mm Hg s cm; P = 0.011), and reduced upper esophageal sphincter relaxation pressure (5 [4, 6] to 2 [1,3] mm Hg; P = 0.001) but no change to velopharyngeal pressures (135 [123, 147] to 137 [117, 157] mm Hg s cm; P = .850) postsurgery. CONCLUSIONS Modified uvulopalatopharyngoplasty may have less implications on the swallow mechanism than previously suspected. In contrast, the reduction in mesopharyngeal contractile pressures associated with coblation channeling of the tongue, although within normal limits, may affect bolus propulsion. Biomechanical alterations were insufficient to worsen self-reported swallowing function. CITATION Schar MS, Omari TI, Woods CW, et al. Swallowing biomechanics before and following multi-level upper airway surgery for obstructive sleep apnea. J Clin Sleep Med. 2022;18(4):1167-1176.
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Affiliation(s)
- Mistyka S. Schar
- Department of Speech Pathology, Flinders Medical Centre, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, South Australia, Australia
| | - Taher I. Omari
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, South Australia, Australia
| | - Charmaine M. Woods
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, South Australia, Australia
- Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Charles Cock
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, South Australia, Australia
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Sebastian H. Doeltgen
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University Adelaide, South Australia, Australia
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
- Respiratory and Sleep Services, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Danny J. Eckert
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Theodore Athanasiadis
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, South Australia, Australia
- Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Eng H. Ooi
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, South Australia, Australia
- Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
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King SN, Hurley J, Carter Z, Bonomo N, Wang B, Dunlap N, Petruska J. Swallowing dysfunction following radiation to the rat mylohyoid muscle is associated with sensory neuron injury. J Appl Physiol (1985) 2021; 130:1274-1285. [PMID: 33600281 DOI: 10.1152/japplphysiol.00664.2020] [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] [Indexed: 11/22/2022] Open
Abstract
Radiation-based treatments for oropharyngeal and hypopharyngeal cancers result in impairments in swallowing mobility, but the mechanisms behind the dysfunction are not clear. The purpose of this study was to determine if we could establish an animal model of radiation-induced dysphagia in which mechanisms could be examined. We hypothesized that 1) radiation focused at the depth of the mylohyoid muscle would alter normal bolus transport and bolus size and 2) radiation to the mylohyoid muscle will induce an injury/stress-like response in trigeminal sensory neurons whose input might modulate swallow. Rats were exposed to 48 or 64 Gy of radiation to the mylohyoid given 8 Gy in 6 or 8 fractions. Swallowing function was evaluated by videofluoroscopy 2 and 4 wk following treatment. Neuronal injury/stress was analyzed in trigeminal ganglion by assessing activating transcription factor (ATF)3 and GAP-43 mRNAs at 2, 4, and 8 wk post treatment. Irradiated rats exhibited decreases in bolus movement through the pharynx and alterations in bolus clearance. In addition, ATF3 and GAP-43 mRNAs were upregulated in trigeminal ganglion in irradiated rats, suggesting that radiation to mylohyoid muscle induced an injury/stress response in neurons with cell bodies that are remote from the irradiated tissue. These results suggest that radiation-induced dysphagia can be assessed in the rat and radiation induces injury/stress-like responses in sensory neurons.NEW & NOTEWORTHY Radiation-based treatments for head and neck cancer can cause significant impairments in swallowing mobility. This study provides new evidence supporting the possibility of a neural contribution to the mechanisms of swallowing dysfunction in postradiation dysphagia. Our data demonstrated that radiation to the mylohyoid muscle, which induces functional deficits in swallowing, also provokes an injury/stress-like response in the ganglion, innervating the irradiated muscle.
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Affiliation(s)
- Suzanne N King
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky
| | - Justin Hurley
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Zachary Carter
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Nicholas Bonomo
- School of Medicine, University of Louisville, Louisville, Kentucky
| | - Brian Wang
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky.,Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Neal Dunlap
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Jeffrey Petruska
- Department of Anatomical Sciences & Neurobiology, University of Louisville, Louisville, Kentucky.,Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
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Smaoui S, Langridge A, Steele CM. The Effect of Lingual Resistance Training Interventions on Adult Swallow Function: A Systematic Review. Dysphagia 2020; 35:745-761. [PMID: 31612288 PMCID: PMC7522100 DOI: 10.1007/s00455-019-10066-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/27/2019] [Indexed: 11/29/2022]
Abstract
Lingual resistance training has been proposed as an intervention to improve decreased tongue pressure strength and endurance in patients with dysphagia. However, little is known about the impact of lingual resistance training on swallow physiology. This systematic review scrutinizes the available evidence regarding the effects of lingual resistance training on swallowing function in studies using Videofluoroscopic Swallowing Studies (VFSS) with adults. Seven articles met the inclusion criteria and underwent detailed review for study quality, data extraction, and planned meta-analysis. Included studies applied this intervention to a stroke and brain injury patient populations or to healthy participants, applied different training protocols, and used a number of outcome measures, making it difficult to generalize results. Lingual resistance training protocols included anterior and posterior tongue strengthening, accuracy training, and effortful press against hard palate with varying treatment durations. VFSS protocols typically included a thin barium stimulus along with one other consistency to evaluate the effects of the intervention. Swallowing measures included swallow safety, efficiency, and temporal measures. Temporal measures significantly improved in one study, while safety improvements showed mixed results across studies. Reported improvements in swallowing efficiency were limited to reductions in thin liquid barium residue in two studies. Overall, the evidence regarding the impact of lingual resistance training for dysphagia is mixed. Meta-analysis was not possible due to differences in methods and outcome measurements across studies. Reporting all aspects of training and details regarding VFSS protocols is crucial for the reproducibility of these interventions. Future investigations should focus on completing robust analyses of swallowing kinematics and function following tongue pressure training to determine efficacy for swallowing function.
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Affiliation(s)
- Sana Smaoui
- Swallowing Rehabilitation Research Laboratory, KITE - Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada.
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, M5G 1V7, Canada.
| | - Amy Langridge
- Swallowing Rehabilitation Research Laboratory, KITE - Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada
| | - Catriona M Steele
- Swallowing Rehabilitation Research Laboratory, KITE - Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, M5G 1V7, Canada
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Martin-Harris B, Canon CL, Bonilha HS, Murray J, Davidson K, Lefton-Greif MA. Best Practices in Modified Barium Swallow Studies. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1078-1093. [PMID: 32650657 PMCID: PMC7844340 DOI: 10.1044/2020_ajslp-19-00189] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/01/2020] [Accepted: 04/11/2020] [Indexed: 05/22/2023]
Abstract
Purpose The modified barium swallow study (MBSS) is a widely used videofluoroscopic evaluation of the functional anatomy and physiology of swallowing that permits visualization of bolus flow throughout the upper aerodigestive tract in real time. The information gained from the examination is critical for identifying and distinguishing the type and severity of swallowing impairment, determining the safety of oral intake, testing the effect of evidence-based frontline interventions, and formulating oral intake recommendations and treatment planning. The goal of this review article is to provide the state of the science and best practices related to MBSS. Method State of the science and best practices for MBSS are reviewed from the perspectives of speech-language pathologists (SLPs) and radiologists who clinically practice and conduct research in this area. Current quandaries and emerging clinical and research trends are also considered. Results This document provides an overview of the MBSS and standards for conducting, interpreting, and reporting the exam; the SLPs' and radiologist's perspectives on standardization of the exam; radiation exposure; technical parameters for recording and reviewing the exam; the importance of an interdisciplinary approach with engaged radiologists and SLPs; and special considerations for examinations in children. Conclusions The MBSS is the primary swallowing examination that permits visualization of bolus flow and swallowing movement throughout the upper aerodigestive tract in real time. The clinical validity of the study has been established when conducted using reproducible and validated protocols and metrics applied according to best practices to provide accurate and reliable information necessary to direct treatment planning and limit radiation exposure. Standards and quandaries discussed in this review article, as well as references, provide a basis for understanding the current best practices for MBSS.
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Affiliation(s)
- Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Cheri L. Canon
- Department of Radiology, The University of Alabama at Birmingham School of Medicine
| | - Heather Shaw Bonilha
- Department of Health Science and Research, Medical University of South Carolina, Charleston
- Department of Otolaryngology—Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Joseph Murray
- Audiology and Speech-Language Pathology Service, VA Ann Arbor Healthcare System, MI
| | - Kate Davidson
- Department of Otolaryngology—Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Maureen A. Lefton-Greif
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
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Effects of Tongue-Strengthening Exercise on the Geniohyoid Muscle in Young Healthy Adults. Dysphagia 2019; 35:110-116. [DOI: 10.1007/s00455-019-10011-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/16/2019] [Indexed: 01/17/2023]
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Yano J, Yamamoto-Shimizu S, Yokoyama T, Kumakura I, Hanayama K, Tsubahara A. Effects of anterior tongue strengthening exercises on posterior tongue strength in healthy young adults. Arch Oral Biol 2019; 98:238-242. [DOI: 10.1016/j.archoralbio.2018.11.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/21/2018] [Accepted: 11/27/2018] [Indexed: 12/17/2022]
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Sia I, Crary MA, Kairalla J, Carnaby GD, Sheplak M, McCulloch T. Derivation and measurement consistency of a novel biofluid dynamics measure of deglutitive bolus-driving function-pharyngeal swallowing power. Neurogastroenterol Motil 2019; 31:e13465. [PMID: 30246422 PMCID: PMC6296874 DOI: 10.1111/nmo.13465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 08/09/2018] [Accepted: 08/15/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND The primary function of the pharyngeal swallowing mechanism is to drive ingested materials into the esophagus. Currently, a definitive measure of pharyngeal bolus-driving function that accounts for bolus movement remains lacking. The primary objectives of this study were to describe the derivation of a novel biofluid dynamics measure of deglutition-that is, pharyngeal swallowing power (PSP)-and to demonstrate the consistency of PSP in normal swallowing. METHODS The pharyngeal swallowing mechanism was conceptualized as a hydraulic power system with the upper esophageal sphincter (UES) as a conduit. PSP was calculated as the product of bolus pressure and flow across the UES. Thirty-four young healthy subjects swallowed materials consisting of two bolus volumes (10, 20 mL) and four bolus viscosities (thin liquid, nectar-thick liquid, honey-thick liquid, pudding). High-resolution impedance manometry was used for data collection. The consistency of PSP across specific bolus conditions was evaluated using standardized Cronbach's coefficient alpha. KEY RESULTS Standardized Cronbach's coefficient alphas in specific bolus conditions ranged between 0.85 and 0.93. Fisher weighted mean Cronbach's coefficient alphas for swallow trials across bolus volumes and across bolus viscosities ranged from 0.86 to 0.90. Fisher weighted mean Cronbach's coefficient alpha for overall consistency of PSP across all swallow trials was 0.88. CONCLUSIONS AND INFERENCES PSP estimates the output power of the pharyngeal bolus-driving mechanism during deglutition. PSP's high consistency indicates that it can be a useful biofluid dynamics measure of pharyngeal bolus-driving function. Current results also demonstrate that consistency in pharyngeal bolus propulsion is an important physiological target for the pharyngeal swallowing mechanism.
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Affiliation(s)
- Isaac Sia
- Department of Rehabilitation, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore, , Fax: +65 6779 7740, Tel: +65 9694 3929
| | - Michael A. Crary
- Swallowing Research Laboratory, University of Central Florida, Orlando, Florida
| | - John Kairalla
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Giselle D. Carnaby
- Swallowing Research Laboratory, University of Central Florida, Orlando, Florida
| | - Mark Sheplak
- Department of Mechanical and Aerospace Engineering and Department of Electrical and Computer Engineering, University of Florida, Gainesville, Florida
| | - Timothy McCulloch
- Division of Otolaryngology–Head and Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin
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Sia I, Crary MA, Kairalla J, Carnaby GD, Sheplak M, McCulloch T. Bolus volume and viscosity effects on pharyngeal swallowing power-How physiological bolus accommodation affects bolus dynamics. Neurogastroenterol Motil 2018; 30:e13481. [PMID: 30324641 DOI: 10.1111/nmo.13481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 08/09/2018] [Accepted: 09/04/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pharyngeal swallowing power (PSP) is a novel measure of pharyngeal bolus-driving function derived from fluid dynamics principles. This study examined the impact of bolus volume and viscosity on PSP to determine bolus effects on pharyngeal bolus dynamics. The impact of bolus accommodation and physical characteristics of boluses were also explored. METHODS Thirty-four healthy subjects swallowed materials consisting of two bolus volumes (10 and 20 mL) and four bolus viscosities (thin liquid, nectar-thick liquid, honey-thick liquid and pudding). High-resolution impedance manometry was used for data collection. The pharyngeal swallowing mechanism was conceptualized as a hydraulic power system with the UES as a conduit, and PSP was calculated as the product of bolus pressure and flow across the UES. The impact of bolus characteristics on PSP was evaluated using a mixed model approach. KEY RESULTS Both bolus volume (F1,32.8 = 412.73, P < 0.0001) and viscosity (F3,84.7 = 28.94, P < 0.0001) were significant predictors of PSP. PSP for 20 mL bolus volume was greater than for 10 mL bolus volume. PSP was lowest in the thin liquid bolus condition and highest in the pudding bolus. All pairwise comparisons among bolus viscosities were significant except between thin liquid and nectar-thick liquid bolus viscosities. Test of linear trend across bolus viscosities was significant (F1,97.2 = 77.25, P < 0.0001). CONCLUSIONS & INFERENCES Pharyngeal swallowing power variation across bolus conditions illustrates bolus-related changes in bolus dynamics. Bolus effects on PSP likely result from physiological bolus accommodation combined with physical characteristics of boluses.
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Affiliation(s)
- Isaac Sia
- Department of Rehabilitation, National University Hospital, Singapore, Singapore
| | - Michael A Crary
- Swallowing Research Laboratory, University of Central Florida, Orlando, Florida
| | - John Kairalla
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Giselle D Carnaby
- Swallowing Research Laboratory, University of Central Florida, Orlando, Florida
| | - Mark Sheplak
- Department of Mechanical and Aerospace Engineering and Department of Electrical and Computer Engineering, University of Florida, Gainesville, Florida
| | - Timothy McCulloch
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin
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Neurons in the dorsomedial medulla contribute to swallow pattern generation: Evidence of inspiratory activity during swallow. PLoS One 2018; 13:e0199903. [PMID: 30024913 PMCID: PMC6053168 DOI: 10.1371/journal.pone.0199903] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/15/2018] [Indexed: 11/20/2022] Open
Abstract
Active contraction of the diaphragm and other inspiratory pump muscles during swallow create a negative thoracic pressure to improve the movement of the bolus (food/liquid) into the esophagus. We tested the hypothesis that dorsomedial medullary inspiratory neurons, including the nucleus tractus solitarius (NTS, pre-motor to the phrenic) would be active during swallow induced by oral water infusion. We recorded neurons in the NTS and medial reticular formation in anesthetized spontaneously breathing cats, and induced swallow by injection of water into the oropharynx. Our results indicate that: 1) a majority of inspiratory cells in the dorsomedial medulla are active during swallow, 2) expiratory neurons are present in the medial reticular formation (deeper to the NTS) in unparalyzed cats and a majority of these cells decreased firing frequency during swallow. Our findings suggest that the dorsomedial medulla is a source of inspiratory motor drive during swallow and that a novel population of breathing-modulated neurons that also are modulated during swallowing exist in the medial reticular formation in unparalyzed animals.
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Park HS, Koo JH, Song SH. Association of Post-extubation Dysphagia With Tongue Weakness and Somatosensory Disturbance in Non-neurologic Critically Ill Patients. Ann Rehabil Med 2017; 41:961-968. [PMID: 29354572 PMCID: PMC5773439 DOI: 10.5535/arm.2017.41.6.961] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/04/2017] [Indexed: 11/05/2022] Open
Abstract
Objective To prospectively assess the association between impoverished sensorimotor integration of the tongue and lips and post-extubation dysphagia (PED). Methods This cross-sectional study included non-neurologic critically ill adult patients who required endotracheal intubation and underwent videofluoroscopic swallowing study (VFSS) between October and December 2016. Participants underwent evaluation for tongue and lip performance, and oral somatosensory function. Demographic and clinical data were retrieved from medical records. Results Nineteen patients without a definite cause of dysphagia were divided into the non-dysphagia (n=6) and the PED (n=13) groups based on VFSS findings. Patients with PED exhibited greater mean duration of intubation (11.85±3.72 days) and length of stay in the intensive care unit (LOS-ICU; 13.69±3.40 days) than those without PED (6.83±5.12 days and 9.50±5.96 days; p=0.02 and p=0.04, respectively). The PED group exhibited greater incidence of pneumonia, higher videofluoroscopy swallow study dysphagia scale score, higher oral transit time, and lower tongue power and endurance and lip strength than the non-dysphagia groups. The differences in two-point discrimination and sensations of light touch and taste among the two groups were insignificant. Patients intubated for more than 7 days exhibited lower maximal tongue power and tongue endurance than those intubated for less than a week. Conclusion Duration of endotracheal intubation, LOS-ICU, and oromotor degradation were associated with PED development. Oromotor degradation was associated with the severity of dysphagia. Bedside oral performance evaluation might help identify patients who might experience post-extubation swallowing difficulty.
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Affiliation(s)
- Hee Seon Park
- Department of Rehabilitation Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jung Hoi Koo
- Department of Rehabilitation Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sun Hong Song
- Department of Rehabilitation Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Hasegawa M, Kurose M, Okamoto K, Yamada Y, Tsujimura T, Inoue M, Sato T, Narumi T, Fujii N, Yamamura K. Differential Response Pattern of Oropharyngeal Pressure by Bolus and Dry Swallows. Dysphagia 2017; 33:83-90. [PMID: 28831570 DOI: 10.1007/s00455-017-9836-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 08/08/2017] [Indexed: 11/26/2022]
Abstract
The aim of this study was to determine if bolus and dry swallow showed similar pressure changes in the oropharynx using our newly developed device. A unique character of it includes that baropressure can be measured with the sensor being placed in the balloon and can assess the swallowing mechanics in terms of pressure changes in the oropharynx with less influences of direct contacts of boluses and oropharyngeal structures during swallow indirectly. Fifteen healthy subjects swallowed saliva (dry), 15 ml of water, 45 ml of water, and 15 ml of two different types of food in terms of viscosity (potage soup-type and mayonnaise-type foods). Suprahyoid muscle activity was recorded simultaneously. Three parameters, area under the curve (AUC), peak amplitude, and duration of pressure, were analyzed from each swallow. Almost all of the bolus swallowing events had biphasic baropressure responses consisting of an early phase and late phase (99%), whereas 90% of the saliva swallowing events had a single phase. AUC, peak, and duration displayed greater effects during the late phase than during the early phase. Baropressure of the early phase, but not of the late phase, significantly increased with increasing volume; however, small but significant viscosity effects on pressure were seen during both phases. Peak pressure of the late phase was preceded by maximum muscle activity, whereas that of the early phase was seen when muscle activity displayed a peak response. These findings indicated that our device with the ability to measure baropressure has the potential to provide additional parameter to assess the swallow physiology, and biphasic baropressure responses in the early and late phases could reflect functional aspects of the swallowing reflexes.
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Affiliation(s)
- Mana Hasegawa
- Division of Oral Physiology, Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-Dori, Chuo-ku, Niigata, 951-8514, Japan
- General Dentistry and Clinical Education Unit, Medical and Dental Hospital, Niigata University, Niigata, Japan
| | - Masayuki Kurose
- Division of Oral Physiology, Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-Dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Keiichiro Okamoto
- Division of Oral Physiology, Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-Dori, Chuo-ku, Niigata, 951-8514, Japan.
| | - Yoshiaki Yamada
- Division of Oral Physiology, Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-Dori, Chuo-ku, Niigata, 951-8514, Japan
- Tokyo Dental College Oral Health Science Center, Tokyo, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Taisuke Sato
- The Institute of Education and Student Affairs, Niigata University, Niigata, Japan
| | | | - Noritaka Fujii
- General Dentistry and Clinical Education Unit, Medical and Dental Hospital, Niigata University, Niigata, Japan
| | - Kensuke Yamamura
- Division of Oral Physiology, Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-Dori, Chuo-ku, Niigata, 951-8514, Japan
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Tomik J, Tomik B, Gajec S, Ceranowicz P, Pihut M, Olszanecki R, Stręk P, Składzień J. The Balloon-Based Manometry Evaluation of Swallowing in Patients with Amyotrophic Lateral Sclerosis. Int J Mol Sci 2017; 18:ijms18040707. [PMID: 28346382 PMCID: PMC5412293 DOI: 10.3390/ijms18040707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/10/2017] [Accepted: 03/22/2017] [Indexed: 11/25/2022] Open
Abstract
The aim of the study was to analyse the disturbances of the oro-pharyngeal swallowing phase of dysphagia in amyotrophic lateral sclerosis (ALS) patients with the use of specific manometric measurements and to evaluate their plausible association with the duration of the disease. Seventeen patients with ALS were evaluated with manometric examinations of the oral and pharyngeal part of the gastrointestinal tract. Tests were carried out by using the oesophageal balloon-based method with four balloon transducers located 5 cm away from each other. The following manometric parameters were analysed: the base of tongue contraction (BTC) and the upper oesophageal sphincter pressure (UESP), and the hypopharyngeal suction pump (HSP) as well as the oro-pharyngeal, pharyngeal and hypopharyngeal transit time and average pharyngeal bolus velocity (oropharyngeal transit time (OTT), pharyngeal transit time (PTT), hypopharyngeal transit time (HTT) and average pharyngeal bolus velocity (APBV), respectively). Manomatric examinations during swallowing in patients with ALS showed significant weakness of BTC, a decrease of HSP and a decrease of the velocity of bolus transit inside the pharynx which were particularly marked between the first and the third examination. Manometric examinations of the oro-pharyngeal part of the gastrointestinal tract are useful and supportive methods in the analysis of swallowing disturbances in ALS patients.
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Affiliation(s)
- Jerzy Tomik
- Ear, Nose & Throat (ENT) Department, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-531, Poland.
| | - Barbara Tomik
- Department of Neurology, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-503, Poland.
| | - Sebastian Gajec
- Ear, Nose & Throat (ENT) Department, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-531, Poland.
| | - Piotr Ceranowicz
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-531, Poland.
| | - Małgorzata Pihut
- Department of Prosthetic Dentistry, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-155, Poland.
| | - Rafał Olszanecki
- Department of Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-531, Poland.
| | - Paweł Stręk
- Ear, Nose & Throat (ENT) Department, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-531, Poland.
| | - Jacek Składzień
- Ear, Nose & Throat (ENT) Department, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-531, Poland.
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Oral and Pharyngeal Function and Dysfunction. Dysphagia 2017. [DOI: 10.1007/174_2017_60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Colangelo LA, Logemann JA, Rademaker AW. Tumor Size and Pretreatment Speech and Swallowing in Patients with Resectable Tumors. Otolaryngol Head Neck Surg 2016; 122:653-61. [PMID: 10793341 DOI: 10.1016/s0194-5998(00)70191-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The pretreatment relationship of tumor burden to speech and swallowing function in 230 patients with oral or oropharyngeal cancer before surgery was assessed. Reduced articulation, reduced conversational understandability, or self-reported dysphagia were present in at least 34% of patients before treatment. Videofluoroscopy showed at least 9% of patients had reduced swallowing efficiency on liquid, paste, or cookie boluses. By use of regression techniques, the percentages of the oral tongue and of the anterior floor of mouth affected by neoplasm were found to be significantly related to reduced articulation; T stage and the percentage of the oral tongue affected with tumor were mildly related to reduced understandability; tumor volume and having soft palate affected by neoplasm were significantly related to self-reported dysphagia; and percentages of affected oral tongue and of affected tongue base were significantly related to reduced swallowing efficiency. Tumor burden may contribute to functional deficits at diagnosis in patients who have resectable tumors.
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Affiliation(s)
- L A Colangelo
- Department of Preventive Medicine and the Robert H. Lurie Cancer Center, Northwestern University Medical School, Chicago, Illinois, USA
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Di Pede C, Mantovani ME, Del Felice A, Masiero S. Dysphagia in the elderly: focus on rehabilitation strategies. Aging Clin Exp Res 2016; 28:607-17. [PMID: 26589905 DOI: 10.1007/s40520-015-0481-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 10/17/2015] [Indexed: 11/25/2022]
Abstract
Prevalence of oropharyngeal dysphagia among the elderly is high, but underestimated and underdiagnosed. It may give raise to relevant complications impacting on morbidity, hospital length of stay and health care costs. Dysphagia evaluation and management is a multidisciplinary task; it includes a detailed history taking, clinical and instrumental exams, and identification of the risk of aspiration. Long-standing individual abilities and impairments determine the goals of an ad hoc rehabilitation program. Currently there are no standard algorithmic approaches for the management of dysphagia in the elderly. Education of health professionals on early diagnosis and improvement of therapeutic strategies are mainstays to allow maximal recovery potential in this population. This narrative review summarizes the current rehabilitation approaches for dysphagia in the elderly. The aim is to inform the treating health care professionals, whether caring physician, physical medicine doctor, speech/swallowing therapist or nurse, on the state-of-the-art and stimulate discussion in the scientific community.
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Affiliation(s)
- C Di Pede
- Rehabilitation Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - M E Mantovani
- Rehabilitation Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - A Del Felice
- Rehabilitation Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - S Masiero
- Rehabilitation Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
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Mok P, Woo P, Schaefer-Mojica J. Hypopharyngeal Pharyngoplasty in the Management of Pharyngeal Paralysis: A New Procedure. Ann Otol Rhinol Laryngol 2016; 112:844-52. [PMID: 14587974 DOI: 10.1177/000348940311201004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dysphagia after a high vagal nerve injury may be associated with a patulous hypopharynx that serves as a reservoir for pharyngeal secretions, contributing to primary or secondary aspiration. We describe a new hypopharyngeal pharyngoplasty procedure for the paralyzed pharynx to improve swallow. The paralyzed pyriform sinus is resected to remove insensate and redundant mucosa. The inferior constrictor muscle is then advanced anterior to the oblique line of the thyroid cartilage to improve pharyngeal tone and prevent pharyngeal dilatation. The surgery is performed in conjunction with medialization laryngoplasty and arytenoid adduction. The utility of this procedure is reviewed retrospectively in 8 patients. They were evaluated by clinical evaluation, fiberoptic endoscopic evaluation of swallow, and modified barium swallow study. All had significant preoperative dysphagia. Three patients were gastrostomy tube-dependent. After operation, all patients had subjective and objective improvements in swallow and progressed to peroral feeding. There were no operative complications. We conclude that hypopharyngeal pharyngoplasty diminishes pyriform sinus pooling and improves pharyngeal transit. Dysphagia patients with unilateral pharyngeal paralysis secondary to cranial nerve palsies may benefit from this new procedure.
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Affiliation(s)
- Paul Mok
- Grabscheid Voice Center, Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York 10129, USA
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21
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Matsubara K, Kumai Y, Kamenosono Y, Samejima Y, Yumoto E. Effect of three different chin-down maneuvers on Swallowing pressure in healthy young adults. Laryngoscope 2015; 126:437-41. [DOI: 10.1002/lary.25552] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 06/03/2015] [Accepted: 07/09/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Keigo Matsubara
- Department of Otolaryngology Head and Neck Surgery; Kumamoto University Graduate School of Medicine; Kumamoto Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology Head and Neck Surgery; Kumamoto University Graduate School of Medicine; Kumamoto Japan
| | - Yuta Kamenosono
- Department of Otolaryngology Head and Neck Surgery; Kumamoto University Graduate School of Medicine; Kumamoto Japan
| | - Yasuhiro Samejima
- Department of Otolaryngology Head and Neck Surgery; Kumamoto University Graduate School of Medicine; Kumamoto Japan
| | - Eiji Yumoto
- Department of Otolaryngology Head and Neck Surgery; Kumamoto University Graduate School of Medicine; Kumamoto Japan
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Lenius K, Stierwalt J, LaPointe LL, Bourgeois M, Carnaby G, Crary M. Effects of Lingual Effort on Swallow Pressures Following Radiation Treatment. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2015; 58:687-697. [PMID: 25812179 DOI: 10.1044/2015_jslhr-s-14-0210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 02/26/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE This article investigated the effects of increased oral lingual pressure on pharyngeal pressures during swallowing in patients who have undergone radiotherapy for head and neck cancer. It was hypothesized that increased oral lingual pressure would result in increased pharyngeal pressures. METHOD A within-subject experimental design was used with 20 participants who were status post external beam radiotherapy for head and neck cancer. Participants completed typical swallows and swallows with increased lingual force during manofluoroscopic swallow studies. The swallow condition order was randomized across participants. RESULTS Manometric data revealed significant differences in swallow pressure by condition at the base of tongue and upper esophageal sphincter sensor locations without significant pressure differences in the lower pharynx. The effortful lingual swallows resulted in higher mean pressures at all locations. CONCLUSIONS The results of this study suggest that use of a maneuver designed to increase oral tongue effort can also increase pharyngeal tongue base pressure. Therefore, therapeutic activities used to generate greater pressure of the oral tongue may also alter pharyngeal response. Further research is needed to determine the direct clinical effect on swallow function for individuals with head and neck cancer.
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Pitts T, Gayagoy AG, Rose MJ, Poliacek I, Condrey JA, Musslewhite MN, Shen TY, Davenport PW, Bolser DC. Suppression of Abdominal Motor Activity during Swallowing in Cats and Humans. PLoS One 2015; 10:e0128245. [PMID: 26020240 PMCID: PMC4447283 DOI: 10.1371/journal.pone.0128245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 04/23/2015] [Indexed: 11/18/2022] Open
Abstract
Diseases affecting pulmonary mechanics often result in changes to the coordination of swallow and breathing. We hypothesize that during times of increased intrathoracic pressure, swallow suppresses ongoing expiratory drive to ensure bolus transport through the esophagus. To this end, we sought to determine the effects of swallow on abdominal electromyographic (EMG) activity during expiratory threshold loading in anesthetized cats and in awake-healthy adult humans. Expiratory threshold loads were applied to recruit abdominal motor activity during breathing, and swallow was triggered by infusion of water into the mouth. In both anesthetized cats and humans, expiratory cycles which contained swallows had a significant reduction in abdominal EMG activity, and a greater percentage of swallows were produced during inspiration and/or respiratory phase transitions. These results suggest that: a) spinal expiratory motor pathways play an important role in the execution of swallow, and b) a more complex mechanical relationship exists between breathing and swallow than has previously been envisioned.
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Affiliation(s)
- Teresa Pitts
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States of America
- * E-mail:
| | - Albright G. Gayagoy
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
| | - Melanie J. Rose
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
| | - Ivan Poliacek
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
| | - Jillian A. Condrey
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
| | - M. Nicholas Musslewhite
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
| | - Tabitha Y. Shen
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
| | - Paul W. Davenport
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
| | - Donald C Bolser
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
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Evaluation of Hypopharyngeal Suction to Eliminate Aspiration: The Retro-Esophageal Suction (REScue) Catheter. Dysphagia 2014; 30:74-9. [DOI: 10.1007/s00455-014-9576-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
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Spearman DG, Poliacek I, Rose MJ, Bolser DC, Pitts T. Variability of the pharyngeal phase of swallow in the cat. PLoS One 2014; 9:e106121. [PMID: 25171095 PMCID: PMC4149527 DOI: 10.1371/journal.pone.0106121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/28/2014] [Indexed: 11/18/2022] Open
Abstract
Objective The pharyngeal phase of swallow has been thought to be a stereotypical motor behavior. Study Design This is a prospective, preclinical, hypothesis driven, one group by three-task design. Methods We sought to compare the effects of pharyngeal swabbing, water only, and water plus punctate mechanical stimulation on the spatiotemporal features of the pharyngeal phase of swallow in the cat. Swallow was elicited under these three conditions in six anaesthetized cats. Electromyographic activity was recorded from seven muscles used to evaluate swallow: mylohyoid, geniohyoid, thyrohyoid, thyroarytenoid, thyropharyngeus, cricopharyngeus, and parasternal. Results Pharyngeal swabbing in comparison to the other stimulus conditions, results in decreases in post-swallow cricopharyngeus activity (upper esophageal sphincter); a significant increase in parasternal (schluckatmung; swallow breath) activity; and increases in thyrohyoid (laryngeal elevator), thyroarytenoid (laryngeal adductor) and parasternal muscles burst duration. Pearson correlations were found of moderate strength between 19% of burst duration comparisons and weak to moderate relationships between 29% of burst amplitude comparisons. However, there were no positive significant relationships between phase durations and electromyogram amplitudes between any of the muscles studied during swallow. Conclusions The results support the concept that a stereotypical behavior, such as pharyngeal swallowing in animal models, can be modified by sensory feedback from pharyngeal mucosal mechanoreceptors. Furthermore, differences in swallow phase durations and amplitudes provide evidence that separate regulatory mechanisms exist which regulate spatial and temporal aspects of the behavior.
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Affiliation(s)
- Daniel G. Spearman
- Department of Physiological Sciences, University of Florida, Gainesville, Florida, United States of America
| | - Ivan Poliacek
- Department of Physiological Sciences, University of Florida, Gainesville, Florida, United States of America
- Institute of Medical Biophysics, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic
| | - Melanie J. Rose
- Department of Physiological Sciences, University of Florida, Gainesville, Florida, United States of America
| | - Donald C. Bolser
- Department of Physiological Sciences, University of Florida, Gainesville, Florida, United States of America
| | - Teresa Pitts
- Department of Physiological Sciences, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
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Gao Z, Kohyama K. Ultrasound Pulsed Wave Doppler Imaging of the Esophagus Illustrates the Effects of Water Volume on Bolus Kinematics. J Texture Stud 2014. [DOI: 10.1111/jtxs.12077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Zhihong Gao
- Food Physics Laboratory; Food Function Division; National Food Research Institute; National Agriculture and Food Research Organization; 2-1-12, Kannondai Tsukuba Ibaraki 305-8642 Japan
| | - Kaoru Kohyama
- Food Physics Laboratory; Food Function Division; National Food Research Institute; National Agriculture and Food Research Organization; 2-1-12, Kannondai Tsukuba Ibaraki 305-8642 Japan
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Fujiwara S, Ono T, Minagi Y, Fujiu-Kurachi M, Hori K, Maeda Y, Boroumand S, Nitschke I, Ursula V, Bohlender J. Effect of supraglottic and super-supraglottic swallows on tongue pressure production against hard palate. Dysphagia 2014; 29:655-62. [PMID: 25055757 DOI: 10.1007/s00455-014-9556-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 06/23/2014] [Indexed: 11/28/2022]
Abstract
The objectives of this study were to evaluate the state of tongue pressure production during supraglottic swallow (SS) and super-supraglottic swallow (SSS) performed by healthy adults, and to investigate the effects of these swallowing maneuvers on the oral stage of swallowing. The participants were 19 healthy individuals. Tongue pressure against the hard palate during swallowing was measured using a tongue pressure sensor sheet system with five pressure-sensitive points. The tasks comprised swallowing 5 mL of water by normal wet swallow, SS, and SSS, and the parameters for analysis were the duration, the maximal magnitude, and the integrated value of tongue pressure during swallowing. The duration of tongue pressure was significantly longer at the anterior-median part of the hard palate during both SS and SSS than with normal wet swallow. The maximal magnitude increased significantly only at the posterior part of the hard palate during SS, but at all points during SSS. The integrated value increased significantly only at the posterior-median part of the hard palate during SS, but at all points except the mid-median part of the hard palate during SSS. The maximal magnitude and integrated value were also significantly higher at the anterior-median and posterior circumferential parts during SSS than during SS. These results show that these two swallowing maneuvers, which are known primarily as techniques to protect the airway, also function to strengthen the tongue pressure produced by the contact between the tongue and the hard palate during swallowing and this effect is more pronounced during SSS.
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Affiliation(s)
- Shigehiro Fujiwara
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamada-oka, Suita, Osaka, 565-0871, Japan
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Lin T, Xu G, Dou Z, Lan Y, Yu F, Jiang L. Effect of bolus volume on pharyngeal swallowing assessed by high-resolution manometry. Physiol Behav 2014; 128:46-51. [PMID: 24518872 DOI: 10.1016/j.physbeh.2014.01.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 01/15/2014] [Accepted: 01/26/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Solid-state high-resolution manometry (HRM) is fast becoming the gold standard for studying pharyngeal and esophageal motility. However, very few studies have ever evaluated the effect of bolus volume on the physiology of swallowing using HRM. We aimed to determine the effect of bolus volume on pressure, duration and velocity of the hypopharynx as well as the upper esophageal sphincter during pharyngeal swallowing using HRM. METHODS Thirty-four healthy subjects completed nine swallows (3 ml, 5 ml and 10 ml of water, thick liquid, and paste, respectively) in the natural sitting position. Pressure and duration measurements were acquired from the hypopharynx and upper esophageal sphincter (UES) using HRM. The UES residual pressure, UES relaxation duration, maximum preopening UES pressure, maximum postclosure UES pressure, maximum hypopharyngeal pressure, maximum hypopharyngeal pressure rise rate and hypopharyngeal pressure duration were analyzed across bolus volumes using repeated measures of one-way analysis of variance. RESULTS A significant increase in UES residual pressure associated with increased bolus volume during water and paste swallowing was observed. Furthermore, UES relaxation duration was significantly increased with increasing in bolus volume for all three material swallows. No significant volume effects were found on the hypopharynx. CONCLUSIONS In summary, bolus volume has a significant effect on the residual pressure and relaxation duration, but no effect on maximum preopening pressure or maximum postclosure pressure of the UES. Maximum hypopharyngeal pressure, maximum hypopharyngeal pressure rise rate and pressure duration were also not affected by bolus volume. Consideration of these variables is paramount in understanding normal and pathological swallowing.
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Affiliation(s)
- Tuo Lin
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guangqing Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yue Lan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Fan Yu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lisheng Jiang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Lan Y, Xu G, Dou Z, Wan G, Yu F, Lin T. Biomechanical changes in the pharynx and upper esophageal sphincter after modified balloon dilatation in brainstem stroke patients with dysphagia. Neurogastroenterol Motil 2013; 25:e821-9. [PMID: 23941282 DOI: 10.1111/nmo.12209] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 07/20/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND Few studies have investigated the biomechanical changes in the upper esophageal sphincter (UES) and pharyngeal function after successful dilatation therapy for dysphagia. Using high-resolution manometry (HRM), we examined the biomechanical properties of swallowing in brainstem stroke patients with dysphagia following modified balloon dilation therapy. METHODS 30 brainstem stroke patients with dysphagia were included. Patients in the experimental group received 3 weeks of modified balloon dilatation treatment and regular dysphagia therapy. Patients in the control group received 3 weeks of regular dysphagia therapy only. Efficacy of treatment was evaluated before and following intervention. Functional oral intake was measured using the Functional Oral Intake Scale (FOIS). Pharyngeal maximum pressures and duration, UES residual pressure and duration during swallowing were measured using HRM. KEY RESULTS In the experimental group, the feeding tube was able to be removed in 12 of 15 patients, vs 2 of 15 patients in the control group. The experimental group had 4-point median improvement, while control groups only had 1-point improvement in FOIS scores. In the experimental group, posttreatment UES relaxation and pharyngeal propulsion were both significantly improved for the three materials (p < 0.05) and UES resting pressure approximated normal. In the control group, pharyngeal propulsion was improved for water and thick liquids (p < 0.05) but not for paste material; there was no improvement in posttreatment UES relaxation for all three materials (p > 0.05). CONCLUSIONS & INFERENCES Dysphagia therapy with modified dilatation improved UES relaxation, strengthened pharyngeal propulsion, restored UES resting pressure and improved functional oral intake to a greater extent than regular therapy alone.
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Affiliation(s)
- Y Lan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Fukuoka T, Ono T, Hori K, Tamine KI, Nozaki S, Shimada K, Yamamoto N, Fukuda Y, Domen K. Effect of the Effortful Swallow and the Mendelsohn Maneuver on Tongue Pressure Production against the Hard Palate. Dysphagia 2013; 28:539-47. [DOI: 10.1007/s00455-013-9464-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 03/19/2013] [Indexed: 10/27/2022]
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Geng Z, Hoffman MR, Jones CA, McCulloch TM, Jiang JJ. Three-dimensional analysis of pharyngeal high-resolution manometry data. Laryngoscope 2013; 123:1746-53. [PMID: 23417441 DOI: 10.1002/lary.23987] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS High-resolution manometry (HRM) represents a critical advance in the quantification of swallow-related pressure events in the pharynx. Previous analyses of the pressures measured by HRM, though, have been largely two-dimensional, focusing on a single sensor in a given region. We present a three-dimensional approach that combines information from adjacent sensors in a region. Two- and three-dimensional methods were compared for their ability to classify data correctly as normal or disordered. STUDY DESIGN Case series evaluating new method of data analysis. METHODS A total of 1,324 swallows from 16 normal subjects and 61 subjects with dysphagia were included. Two-dimensional single sensor integrals of the area under the curves created by rises in pressure in the velopharynx, tongue base, and upper esophageal sphincter (UES) were calculated. Three-dimensional multi-sensor integrals of the volume under all curves corresponding to the same regions were also computed. The two sets of measurements were compared for their ability to classify data correctly as normal or disordered using an artificial neural network (ANN). RESULTS Three-dimensional parameters yielded a maximal classification accuracy of 86.71% ± 1.47%, while two-dimensional parameters achieved a maximum accuracy of 83.36% ± 1.42%. Combining two- and three-dimensional parameters with all other variables, including three-dimensional parameters, yielded a classification accuracy of 96.99% ± 0.51%. Including two-dimensional parameters yielded a classification accuracy of 96.32% ± 1.05%. CONCLUSION Three-dimensional analysis led to improved classification of swallows based on pharyngeal HRM. Artificial neural network performance with both two-dimensional and three-dimensional analyses was effective, classifying a large percentage of swallows correctly, thus demonstrating its potential clinical utility.
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Affiliation(s)
- Zhixian Geng
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Amin MR, Lazarus CL, Pai VM, Mulholland TP, Shepard T, Branski RC, Wang EY. 3 Tesla turbo-FLASH magnetic resonance imaging of deglutition. Laryngoscope 2012; 122:860-4. [PMID: 22253090 DOI: 10.1002/lary.22496] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 09/27/2011] [Accepted: 10/18/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS In this article we describe a methodology for obtaining high-quality dynamic magnetic resonance imaging (MRI) sequences of the swallow sequence in healthy volunteers. The study includes comparison to previous work done in our lab using a 1.5 Tesla (T) magnet. STUDY DESIGN Case series. METHODS Three healthy volunteers underwent turbo-fast low angle shot MRI at 3T while swallowing liquid boluses delivered via intravenous tubing to the oral cavity. Imaging was performed in the sagittal and axial planes. RESULTS Imaging provided by this sequence provided high temporal resolution, with the ability to depict deglutition in the axial and sagittal planes. Comparison with imaging at 1.5 T demonstrated benefits in temporal resolution and signal-to-noise. Anatomic information provided differed from comparative videofluoroscopy. CONCLUSIONS MRI of swallowing using the described technique is reliable and provides a unique evaluation of the swallowing sequence.
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Affiliation(s)
- Milan R Amin
- New York University Voice Center, Department of Otolaryngology/Head and Neck Surgery, New York University School of Medicine, New York, New York 10016, USA.
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Takasaki K, Umeki H, Hara M, Kumagami H, Takahashi H. Influence of effortful swallow on pharyngeal pressure: evaluation using a high-resolution manometry. Otolaryngol Head Neck Surg 2011; 144:16-20. [PMID: 21493381 DOI: 10.1177/0194599810390885] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effect of effortful swallow on pharyngeal pressure while swallowing saliva and water using a novel high-resolution manometry (HRM) system. STUDY DESIGN Case series with planned data collection. SETTING Nagasaki University Hospital. SUBJECTS AND METHODS Eighteen asymptomatic Japanese adult volunteers were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned from the velopharynx to the upper esophagus to record pressures while swallowing. The maximum values of the pressure while swallowing saliva (dry swallowing) and 5 mL of water were measured at the velopharynx, meso-hypopharynx, and upper esophageal sphincter (UES) with and without effortful swallows. RESULTS The maximum values of dry swallowing pressures (mm Hg) at the velopharynx, meso-hypopharynx, and UES were significantly higher with effortful swallow (155.7 ± 59.7, 256.7 ± 78.7, and 276.5 ± 87.5, mean ± standard deviation) than without it (115.3 ± 60.8, 172.9 ± 57.0, and 195.8 ± 61.3). Those of water swallowing pressures were also statistically higher with effortful swallow (169.3 ± 69.1, 236.6 ± 77.2, and 267.3 ± 79.1) than without it (119.2 ± 59.7, 189.5 ± 70.7, and 221.3 ± 72.7). CONCLUSION The present results provide quantitative evidence of effortful swallow as well as physiological information. It also is hoped to be an aid to future clinical and investigative studies.
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Affiliation(s)
- Kenji Takasaki
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
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Olsson R. Pharyngeal Manometry. Dysphagia 2011. [DOI: 10.1007/174_2011_343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Oral and Pharyngeal Function and Dysfunction. Dysphagia 2011. [DOI: 10.1007/174_2011_391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Comparison of Three Types of Tongue Pressure Measurement Devices. Dysphagia 2010; 26:232-7. [DOI: 10.1007/s00455-010-9291-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
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The effects of aspiration status, liquid type, and bolus volume on pharyngeal peak pressure in healthy older adults. Dysphagia 2010; 26:225-31. [PMID: 20623303 DOI: 10.1007/s00455-010-9290-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
Abstract
The reasons for aspiration in healthy adults remain unknown. Given that the pharyngeal phase of swallowing is a key component of the safe swallow, it was hypothesized that healthy older adults who aspirate are likely to generate less pharyngeal peak pressures when swallowing. Accordingly, pharyngeal and upper esophageal sphincter pressures were examined as a function of aspiration status (i.e., nonaspirator vs. aspirator), sensor location (upper vs. lower pharynx), liquid type (i.e., water vs. milk), and volume (i.e., 5 vs. 10 ml) in healthy older adults. Manometric measurements were acquired with a 2.1-mm catheter during flexible endoscopic evaluation. Participants (N = 19, mean age = 79.2 years) contributed 28 swallows; during 8 swallows, simultaneous manometric measurements of upper and lower pharyngeal and upper esophageal pressures were obtained. Pharyngeal manometric peak pressure was significantly less for aspirators (mean = 82, SD = 31 mmHg) than for nonaspirators (mean = 112, SD = 20 mmHg), and upper pharyngeal pressures (mean = 85, SD = 32 mmHg) generated less pressure than lower pharyngeal pressures (mean = 116, SD = 38 mmHg). Manometric measurements vary with respect to aspiration status and sensor location. Lower pharyngeal pressures in healthy older adults may predispose them to aspiration.
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Lazarus CL. Effects of Chemoradiotherapy on Tongue Function in Patients With Head and Neck Cancer. ACTA ACUST UNITED AC 2009. [DOI: 10.1044/sasd18.2.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
In this review article, the effects of radiotherapy ± chemotherapy on tissues and on oropharyngeal swallowing are reviewed. In addition, normal tongue function for swallowing is reviewed, as are the effects of tongue exercise programs designed to improve tongue strength and swallow functioning. Current literature on swallow exercise programs for head and neck cancer patients is provided. Also discussed are potential new avenues for research in this population.
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Affiliation(s)
- Cathy L. Lazarus
- Department of Otolaryngology, New York University School of MedicineNew York, NY
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YOSHIKAWA M, YOSHIDA M, NAGASAKI T, TANIMOTO K, TSUGA K, AKAGAWA Y. Effects of tooth loss and denture wear on tongue-tip motion in elderly dentulous and edentulous people. J Oral Rehabil 2008; 35:882-8. [DOI: 10.1111/j.1365-2842.2008.01882.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
This article describes the evidence for the physiologic foundation and interpretation of the videofluorographic swallowing study (VFSS). The purpose and clinical efficacy of VFSS are explained. Standardization of the VFSS procedure, protocol, interpretation, and reporting is highlighted as a critical step in future clinical practice and research. Individualized evidenced-based rehabilitation strategies are presented as key components that are systematically applied during the VFSS procedure and integrated into the swallowing management plan. A new tool that has been developed and tested for the quantification of swallowing impairment is introduced.
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Affiliation(s)
- Bonnie Martin-Harris
- Director, MUSC Evelyn Trammell Institute for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery Medical University of South Carolina, Charleston, South Carolina
- Medical University of South Carolina, Department of Communication Sciences & Disorders
- Professor, Otolaryngology-Head and Neck Surgery
- Saint Joseph's Hospital of Atlanta, Evelyn Trammell Voice and Swallowing Center
| | - Bronwyn Jones
- Professor of Radiology, The Russell H. Morgan Department of Radiology and Radiological Sciences
- The Johns Hopkins University School of Medicine
- The Johns Hopkins Hospital, Department of Radiology, Baltimore, MD
- Director, Johns Hopkins Swallowing Center, The Johns Hopkins Hospital
- Editor-in-Chief, Dysphagia, Spring Publishers, New York, NY
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Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment--MBSImp: establishing a standard. Dysphagia 2008; 23:392-405. [PMID: 18855050 DOI: 10.1007/s00455-008-9185-9] [Citation(s) in RCA: 405] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 08/06/2008] [Indexed: 02/07/2023]
Abstract
The aim of this study was to test reliability, content, construct, and external validity of a new modified barium swallowing study (MBSS) tool (MBSImp) that is used to quantify swallowing impairment. Multiple regression, confirmatory factor, and correlation analyses were used to analyze 300 in- and outpatients with heterogeneous medical and surgical diagnoses who were sequentially referred for MBS exams at a university medical center and private tertiary care community hospital. Main outcome measures were the MBSImp and index scores of aspiration, health status, and quality of life. Inter- and intrarater concordance were 80% or greater for blinded scoring of MBSSs. Regression analysis revealed contributions of eight of nine swallow types to impressions of overall swallowing impairment (p < or = 0.05). Factor analysis revealed 13 significant components (loadings >/= 0.5) that formed two impairment groupings (oral and pharyngeal). Significant correlations were found between Oral and Pharyngeal Impairment scores and Penetration-Aspiration Scale scores, and indexes of intake status, nutrition, health status, and quality of life. The MBSImp demonstrated clinical practicality, favorable inter- and intrarater reliability following standardized training, content, and external validity. This study reflects potential for establishment of a new standard for quantification and comparison of oropharyngeal swallowing impairment across patient diagnoses as measured on MBSS.
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Affiliation(s)
- Bonnie Martin-Harris
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425-5500, USA.
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Taniguchi H, Tsukada T, Ootaki S, Yamada Y, Inoue M. Correspondence between food consistency and suprahyoid muscle activity, tongue pressure, and bolus transit times during the oropharyngeal phase of swallowing. J Appl Physiol (1985) 2008; 105:791-9. [PMID: 18556429 DOI: 10.1152/japplphysiol.90485.2008] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aimed to evaluate the effects of food texture and viscosity on the swallowing function by measuring tongue pressure and performing a videofluorographic (VF) examination. Eleven normal adults were recruited for this study. Test foods with different consistencies and liquid contents, i.e., a half-solid nutrient made of 0.8 and 1.5% agar powder, syrup, and a liquid containing 40 wt/vol% barium sulfate, were swallowed, and the anterior (AT) and posterior tongue pressures (PT) and electromyographic (EMG) activity of the suprahyoid muscles were recorded, together with VF images. The timing of each event obtained from EMG, tongue pressure, and VF recordings was measured and then compared. We found that the AT and PT activity patterns were similar and showed a single peak. The peak, area, and time duration of all of the variables for AT and PT and EMG burst increased with increasing hardness of the bolus. The onset of the EMG burst always preceded those of the AT and PT activities, while there were no significant differences in peak and offset times among EMG burst, AT, and PT. Total swallowing time and oral ejection time were significantly longer during the swallowing of 1.5% agar than any other boluses, while pharyngeal transit time and clearance time were significantly longer during the swallowing of syrup, which was as hard as the liquid, but showed a higher viscosity than the liquid. The results suggested that the major effects of food hardness were to delay oral ejection time, which strongly delays total swallowing time. In addition, pharyngeal bolus transit is not dependent on the hardness of food but on its viscosity.
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Affiliation(s)
- Hiroshige Taniguchi
- Div. of Dysphagia Rehabilitation, Niigata Univ. Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata 951-8514, Japan
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Witte U, Huckabee ML, Doeltgen SH, Gumbley F, Robb M. The effect of effortful swallow on pharyngeal manometric measurements during saliva and water swallowing in healthy participants. Arch Phys Med Rehabil 2008; 89:822-8. [PMID: 18452727 DOI: 10.1016/j.apmr.2007.08.167] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 08/20/2007] [Accepted: 08/21/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effect of effortful swallow on pharyngeal manometric pressure measurements during saliva and water swallowing. DESIGN Comparative analysis of pharyngeal pressure generation under 2 bolus and 2 task conditions. SETTING Swallowing rehabilitation research laboratory. PARTICIPANTS Healthy participants (N=40), sex equally represented, with a mean age of 25.8 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Manometric peak and nadir amplitude and duration measures at 3 locations in the pharynx. RESULTS Significantly higher peak pressures were measured for saliva swallows compared with water swallows under both swallowing conditions at the proximal pharyngeal sensor only (P=.011). No significant differences were observed between the effortful versus noneffortful conditions at the proximal and midpharyngeal sensors; however, upper esophageal sphincter (UES) nadir pressures were significantly lower for effortful than noneffortful swallows (P=.034) with significantly lower pressure measurements in saliva effortful swallows (P=.008) compared with water effortful swallows. Saliva swallows resulted in significantly longer pressure durations than water swallows at the proximal (P=.003) and middle (P=.048) sensors. Pressure-generation duration was significantly longer in effortful versus noneffortful swallows for the middle sensor (P=.036) only. CONCLUSIONS The results indicate that the effect of effortful swallow on pharyngeal peak pressure measurement is not altered by bolus type (saliva vs water). However, this is not the case for nadir pressure measurements in the UES, which were significantly lower in effortful saliva swallows than in effortful water swallows.
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Affiliation(s)
- Ulrike Witte
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand.
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Gumbley F, Huckabee ML, Doeltgen SH, Witte U, Moran C. Effects of Bolus Volume on Pharyngeal Contact Pressure During Normal Swallowing. Dysphagia 2008; 23:280-5. [DOI: 10.1007/s00455-007-9137-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 10/22/2007] [Indexed: 11/29/2022]
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Goeleven A, Robberecht W, Sonies B, Carbonez A, Dejaeger E. Manofluorographic evaluation of swallowing in amyotrophic lateral sclerosis and its relationship with clinical evaluation of swallowing. ACTA ACUST UNITED AC 2007; 7:235-40. [PMID: 17127562 DOI: 10.1080/17482960600664870] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this cross-sectional study was, first, to identify swallowing dysfunctions in an ALS population of 40 consecutive patients through combined videofluoroscopy and manometry. Secondly, these objective swallowing data were correlated with the functional feeding status as reported by the patient or family member. Videofluoroscopic evaluation showed dysfunctions in the oral phase of swallowing, pharyngeal initiation and pharyngeal transport. In addition, manometric data revealed low tongue driving forces and pharyngeal contraction amplitudes but normal relaxation of the upper oesophageal sphincter (UES). Aspiration was noted in a not negligible number of 9/40 patients. These objective data were then correlated with the clinical swallowing and feeding status, assessed by means of the ALS Swallowing Severity Scale. Patients receiving scores of 6 or lower on the ALSSSS, report dietary consistency changes but are considered 'safe oral feeders'. Nevertheless, our data revealed that these patients showed significant aspiration during videofluoroscopy. Although not every patient with ALS should be referred routinely for radiographic evaluation of swallowing, our findings suggest referral for a radiological examination as soon as the ALSSSS drops to a score of 6 or lower, to evaluate the presence of (silent) aspiration.
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Affiliation(s)
- Ann Goeleven
- Department of ENT Head and Neck Surgery, University Hospitals Leuven, Swallowing Clinic, Leuven, Belgium.
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Ball S, Idel O, Cotton SM, Perry A. Comparison of Two Methods for Measuring Tongue Pressure During Swallowing in People with Head and Neck Cancer. Dysphagia 2006; 21:28-37. [PMID: 16544088 DOI: 10.1007/s00455-005-9008-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Reliable measurement tools are essential to achieve rigor in dysphagia research. In order for tongue pressure to be measured accurately in the head and neck cancer population, where change in function needs to be captured over time, a reliable tool is required. Assessing the reliability of tools that are used in swallowing evaluation has been a neglected area of dysphagia research. This article evaluates and compares the reliability of two variants of the Kay Swallowing Workstation (KSW) three-bulb silicon tongue pressure array (hand-held and fixed-position) when used to capture oral tongue pressures in two groups of participants diagnosed with head and neck cancer who had not yet commenced cancer treatment. Tongue pressure data and videofluoroscopic images were collected and recorded simultaneously onto the KSW while participants swallowed set quantities of liquid and pudding boluses. Peak amplitude tongue pressures were extracted and used in analyses. Systematic and nonsystematic variability were examined using analysis of variance and intraclass correlation coefficients, respectively. The fixed-position array demonstrated better reliability than did the hand-held method. This should be further investigated with a larger participant sample.
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Affiliation(s)
- Sarah Ball
- Speech Pathology Department, Western Health Service, Victoria, Australia
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Kelly BN, Huckabee ML, Jones RD, Frampton CMA. Nutritive and non-nutritive swallowing apnea duration in term infants: implications for neural control mechanisms. Respir Physiol Neurobiol 2006; 154:372-8. [PMID: 16504603 DOI: 10.1016/j.resp.2006.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Revised: 01/15/2006] [Accepted: 01/18/2006] [Indexed: 10/25/2022]
Abstract
The impact of bolus ingestion and level of consciousness on swallowing apnea duration (SAD) in healthy term infants has not been adequately explored despite the likely contribution of swallowing apnea to upper airway protection against aspiration. SAD during wakefulness, sleep, and feeding (breast or bottle) of 10 term infants was measured 10 times from birth to 1 year of age. Nineteen thousand four hundred and two swallows were analyzed. Irrespective of age, SAD during feeding was significantly shorter than SAD of non-nutritive swallowing (during wakefulness and sleep). SAD did not change significantly within the first year of life in any of the three conditions and there was no change in the relative durations of nutritive, wake and sleep conditions with age. The absence of an age effect implies that the neural mechanisms controlling SAD are fundamentally brainstem-mediated and largely hard-wired at birth in healthy term neonates.
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Affiliation(s)
- Bronwen N Kelly
- Van der Veer Institute for Parkinson's and Brain Research, Christchurch, New Zealand.
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Chi-Fishman G. Quantitative lingual, pharyngeal and laryngeal ultrasonography in swallowing research: a technical review. CLINICAL LINGUISTICS & PHONETICS 2005; 19:589-604. [PMID: 16206486 DOI: 10.1080/02699200500113996] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Because of its distinct advantage in radiation-free soft tissue imaging, ultrasonography has been widely used to study lingual, pharyngeal, hyoid, laryngeal, and even esophageal action during swallowing in individuals of all ages. Qualitative ultrasonographic observations have made considerable contributions to our understanding of deglutition. Quantitative ultrasonographic swallowing research has also grown by leaps and bounds over the years with advances in imaging technologies and analytical methodologies. As a technical primer for new investigators, this paper reviews the modem methods for quantitative analysis in ultrasonographic swallowing research. The intended outcome is a basic understanding of the application of ultrasonography with various analysis options to the quantitative study of the deglutitive action of selected upper aerodigestive structures. Though proven useful for swallowing research, ultrasonography has inherent limitations and methodological issues. Future technological advancement and sophisticated image processing and analysis algorithms will resolve some of these issues.
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Affiliation(s)
- Gloria Chi-Fishman
- Oral Pharyngeal Function & Ultrasound Imaging Laboratory, Physical Disabilities Branch, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1391, USA.
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