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PubMed2002

Surface electromyographic and electroglottographic studies in normal subjects under two swallow conditions: normal and during the Mendelsohn manuever.

Surface electromyography (EMG) has been used successfully in teaching patients swallow maneuvers in clinical settings. The present study aims to determine if surface EMG can reliably demonstrate differences in muscle activity between the normal swallow and the Mendelsohn maneuver and whether there is a close temporal relationship between submental muscles and laryngeal elevation as demonstrated by electroglottography (EGG). Surface EMG was measured from five muscle groups (superior and inferior orbicularis oris, masseter, submental and infrahyoid) in 20 normal subjects under two swallowing conditions: normal and during performance of the Mendelsohn maneuver. A significant difference in EMG activity from the submental muscle group between the normal swallow and the Mendelsohn maneuver indicates that EMG at this location can be used reliably to differentiate between these two swallow conditions. The onset of submental activity and laryngeal elevation occurred within 10 ms of each other. The offset of submental activity and the return of the larynx to its resting position occurred within 24 ms of each other. Regarding the temporal relationship among the five muscle groups, the sequence of the most frequent muscle initiation was orbicularis oris inferior. orbicularis oris superior, masseter. submental muscle group, and infrahyoid muscle group. The sequence of the most frequent muscle termination was orbicularis oris superior, orbicularis oris inferior, masseter, submental muscle group, and infrahyoid muscle group in both normal swallow and the Mendelsohn maneuver.

Adolescent↗
PubMed2003

Interrater reliability of videofluoroscopic swallow evaluation.

The past two decades have brought an enormous widening of interest in and knowledge about swallowing disorders. The most frequently used technique for swallow evaluation is X-ray videofluoroscopy. Most interventions are based on this examination. Only a few studies assessing interobserver reliability of videofluoroscopy have been published. The aim of our study was to assess the interobserver reliability of videofluoroscopy for swallow evaluation. Fifty-one consecutive dysphagic patients referred for videofluoroscopy were entered into the study regardless of their underlying disorder. The first swallow (5 ml of a semisolid radio-opague contrast media) of each patient was assessed in the lateral projection by 9 independent, experienced observers from different international swallow centers. All studies were evaluated according to a standardized protocol sheet and the interobserver reliability was calculated. The interobserver reliabilities assessed as kappa coefficient for parameters of the oral and pharyngeal phase, for the temporal occurrence of penetration/aspiration, and for the location of bolus residue ranged from 0.01 to 0.56. High reliability with an intraclass coefficient of 0.80 was achieved only with the well defined penetration/aspiration score. Our study underlines the need for exact definitions of the parameters assessed by videofluoroscopy, in order to raise interobserver reliability. To date, only aspiration is evaluated with high reliability by videofluoroscopy, whereas the reliability of all other parameters of oropharyngeal swallow is poor.

Adult↗
PubMed2005

Timing of pharyngeal and upper esophageal sphincter pressures as a function of normal and effortful swallowing in young healthy adults.

The effect of effortful swallow on pharyngeal pressure and UES relaxation onsets and durations was examined. Eighteen adults, nine males and nine females (mean age=27.9 yr), participated. Timing of pharyngeal pressure and onset and duration of UES relaxation were measured across ten trials of normal and ten trials of effortful swallows. Results revealed that manometric timing measurements are consistent across trials. The first and second statistical analyses investigated the pharyngeal pressure and UES relaxation onsets and durations, respectively. Both analyses identified a significant interaction of swallow type (i.e., effortful vs. normal) by manometric sensor location (p<0.05). Across normal and effortful swallows, UES relaxation preceded pharyngeal pressure onsets, yet the rate of change (or degree of delay) varied across the sensors. Furthermore, the effortful swallow elicited longer pharyngeal pressure and UES relaxation durations, yet the pressure duration measured in the upper pharynx was significantly longer than that measured lower in the pharynx. These findings offer insight as to the potential positive and negative influence of the effortful swallow on pharyngeal timing.

Adult↗
PubMed2005

Fiberoptic endoscopic evaluation of swallowing (FEES) with and without blue-dyed food.

The purpose of this prospective study was to determine if fiberoptic endoscopic evaluation of swallowing (FEES) maintains high intra- and interrater reliability in detecting pharyngeal dysphagia and aspiration without the addition of FD&C Blue No. 1 to food. Twenty consecutive adults referred for a swallow evaluation participated. Nine subjects received blue-dyed food and 11 subjects received regular nondyed food, i.e., yellow pudding and white skim milk. Four variables were rated: (1) the stage transition characterized by depth of bolus flow to at least the vallecula prior to the pharyngeal swallow; (2) evidence of bolus retention in the vallecula or pyriform sinuses after the pharyngeal swallow; (3) laryngeal penetration defined as material in the laryngeal vestibule but not passing below the level of the true vocal folds either before or after the pharyngeal swallow; and (4) tracheal aspiration defined as material below the level of the true vocal folds either before or after the pharyngeal swallow. Three speech-language pathologists experienced in interpreting FEES results independently and blindly reviewed the digitized videotape three times. Intrarater agreements for the four variables with blue-dyed and non-blue-dyed food trials were 100% and monochrome trials ranged from 95% to 100%. Average kappa values for interrater reliability ranged from moderate to excellent agreement (0.61-1.00) for all viewing conditions. Kappa values for blue-dyed trials versus monochrome trials were 0.83 and for non-blue-dyed trials versus monochrome trials were 0.88, indicative of excellent reliability under both viewing conditions. FEES maintains both high intra- and interrater reliability in detecting the critical features of pharyngeal dysphagia and aspiration using either blue-dyed or non-blue-dyed foods. The endoscopist, therefore, can be assured of reliable FEES results using regular, non-dyed food trials.

Adult↗
PubMed2005

The effects of intraoral pressure sensors on normal young and old swallowing patterns.

Lingual pressure generation plays a crucial role in oropharyngeal swallowing. To more discretely study the dynamic oropharyngeal system, a 3-bulb array of pressure sensors was designed with the Kay Elemetrics Corporation (Lincoln Park, NJ). The influence of the device upon normal swallowing mechanics and boluses representative of flow relative to age and bolus condition was the focus of this study. Twelve healthy adults in two age groups (31 +/- 5 years, 2 males and 4 females, and 78 +/- 7 years, 2 males and 4 females) participated. Each subject was instructed to swallow four boluses representative of conditions with and without three pressure sensors affixed to the hard palate. Post-swallow residue at four locations, Penetration/Aspiration Scale scores, and three bolus flow timing measures were assessed videofluoroscopically with respect to age and bolus condition. The only statistically significant influences attributable to the presence of the pressure sensors were slight increases in residue in the oral cavity and upper esophageal sphincter with some bolus consistencies, 8% more frequent trace penetration of the laryngeal vestibule predominantly with effortful swallowing, and variances in oral clearance duration. We conclude that the presence of the pressure sensors does not significantly alter normal swallowing patterns of healthy individuals.

Adult↗
PubMed2006

Swallowing function outcomes following nonsurgical therapy for advanced-stage laryngeal carcinoma.

The purposes of this study were to (1) evaluate swallowing function using both subjective and objective measures in patients treated nonsurgically for stages III and IV laryngeal squamous cell carcinoma, (2) assess the effect of time from treatment completion on swallowing function, and (3) assess sequelae associated with modality of treatment. To achieve these objectives, a retrospective study of 14 patients was conducted. Fiberoptic endoscopic evaluation of swallowing (FEES) was performed and evaluated by three independent judges for seven functional criteria: standing secretions, valleculae spillage, valleculae residue, postcricoid residue, laryngeal penetration, aspiration, and cough. Patient interviews were performed to establish patient perception of swallowing and his/her current posttreatment diet. Results revealed that each patient exhibited swallowing abnormalities in at least one of the seven objective functional categories studied. Ten patients suffered from variable degrees of dysphagia, ranging from mild to severe, on all measures. No significant differences were noted between those patients with less than or greater than 12 months posttreatment. Common treatment sequelae included PEG tube placement for nutritional supplementation, tracheostomy placement for airway security and/or pulmonary toilet, repeated episodes of aspiration pneumonia requiring hospital admission, and radiation-induced oropharyngeal stricture. Further studies using subjective and objective swallowing function measures for patients treated with alternative chemoradiation regimens versus surgery (with or without adjuvant therapies) for advanced stage laryngeal cancer are needed.

Aged↗
PubMed2006

Change in levator veli palatini muscle activity in relation to swallowing volume during the transition from the oral phase to pharyngeal phase.

The aim of this study was to examine whether the levator veli palatini (LVP) muscle might be involved in the regulation of velopharyngeal function during the transition between the oral and pharyngeal phases during swallowing, and to examine whether LVP muscle activity could be regulated in relation to the volume of swallowing. Eight normal adults participated in this study. Smoothed EMG signals of the LVP muscle were collected. At the same time, palatoglossus muscle activity was also monitored. Each subject swallowed water at five different volumes: 12.5%, 25%, 50%, 100%, and 150 (or 200) % of the optimum volume for swallowing, which was individually determined for each subject. LVP muscle activity was positively correlated with changes in swallowing volume. The LVP muscle was involved in the regulation of swallowing during the transition from the oral to pharyngeal phases.

Adult↗
PubMed2006

Laterality of swallowing in healthy subjects by AP projection using videofluoroscopy.

Although anteroposterior projections in videofluoroscopic examination of swallowing (VF) provide clinically important information, the laterality of swallowing in healthy subjects has not been examined fully to date. One hundred sixty-seven healthy volunteers were prospectively studied. The subjects were asked to swallow 5 ml of barium solution three times while X-ray images were taken that showed the pathway of the solution from the pharynx into the esophagus to assess the laterality of swallowing. We classified patterns of swallowing into three types according to passage in the pharyngoesophageal segment as indicated by width: RD (right-side-dominant flow), LD (left-side-dominant flow), and NL (no laterality in flow). Fifty-eight percent of the subjects were classified as NL, 35% as LD, and 7% as RD. The ratio of types in women was NL:LD:RD = 7:2:1. There were no significant differences among the groups according to age. Although classifications in young men (age = 20-30 years) tended to be the same as in women regardless of age, ratios of LD tended to increase with age; 71% of elderly adults (age = 51-75 years) were classified as LD. These results demonstrate laterality in normal swallowing and will be helpful in determining treatment strategies for the patients with dysphagia.

Adult↗
PubMed2006

Hyoid-bolus transit latencies in normal swallow.

Pharyngeal swallow delay is frequently found in dysphagic patients and is thought to be a factor in a range of swallowing problems, including aspiration. Implicit in notions of swallow "delay" is a temporal interval between two events that is longer than normal. However, there appears to be little agreement about which referent events should be considered in determining delay. A number of pharyngeal bolus transit points and various pharyngeal gestures have been used in delays determined from fluoroscopic evidence, and other referents have been used in electromyographic and manometric studies of swallow. In this study latencies between the first movement of the hyoid and several pharyngeal bolus transit points were calculated from fluoroscopic swallow studies in normal nondysphagic adults. Means and standard deviations of these latencies are provided for a 3-cc and a 20-cc bolus and for both nonelderly and elderly adults. The data may be a useful resource for relating the specific latencies investigated to concepts of pharyngeal swallow delay, in particular, when assessing videofluoroscopic studies using a similar protocol.

Adolescent↗
PubMed2000

Kinematic analysis of laryngeal movements in patients with neurogenic dysphagia before and after swallowing rehabilitation.

To examine whether kinematic analysis of laryngeal movements (which are closely linked to pharyngeal swallowing) can differentiate between normal and disturbed swallowing, we used a three-dimensional ultrasound movement recording system to measure the movements of the larynx during swallowing in 32 patients with neurogenic dysphagia caused by central nervous system lesions and in 32 age- and sex-matched healthy individuals. At the beginning of an inpatient rehabilitation swallowing program, laryngeal movements in 24 patients were highly disturbed in terms of velocity curve irregularities. After rehabilitation, the majority of patients with hitherto irregular velocity profiles exhibited laryngeal kinematics that were indistinguishable from those of 32 healthy subjects. Kinematic analysis of laryngeal movements, therefore, is suitable for monitoring motor recovery of swallowing disturbances in patients with neurogenic dysphagia while undergoing swallowing rehabilitation.

Adult↗
PubMed2000

Respiratory and acoustic signals associated with bolus passage during swallowing.

In order to advance our understanding of the relation between respiration and deglutition, simultaneous videofluoroscopy and respirodeglutometry was performed. Fifteen normal, healthy, young adults (20-29 years of age) were connected to a respirodeglutometer and positioned for simultaneous videofluoroscopic assessment in the lateral plane. Subjects performed three swallows each of a 5-ml and a 10-ml bolus of liquid barium and a 5-ml bolus of paste barium, for a total of nine swallows per subject. Location of the bolus head as identified with videofluoroscopy was associated with eight respirodeglutometric variables. In addition, temporal relations for seven respirodeglutometric variables were calculated as a function of bolus volume and viscosity. Significant temporal differences were found for five of the variables by volume. No significant temporal differences were noted by viscosity. Expiration occurred before 79% and after 96% of the swallows. The number of inspirations preceding a swallow suggested a possible effect resulting from the need to hold a bolus in the mouth before receiving instructions to swallow during videofluoroscopic assessment. This effect may be important during patient evaluation. For a significant number of swallows, respiratory flow ceased before the velum was fully elevated.

Acoustics↗
PubMed2001

Effects of age, gender, bolus volume, and trial on swallowing apnea duration and swallow/respiratory phase relationships of normal adults.

The effects of age, gender, bolus volume, and trial on swallowing apnea duration (SAD) and swallow/respiratory phase relationships were examined. Sixty adults, composed of ten males and ten females in each of three age groups (i.e., 20-39, 40-59, and 60-83 years), participated. SAD was assessed via nasal airflow during saliva swallows and 10-, 15-, 20-, 25-mL bolus volumes across three trials. Results revealed SAD is consistent across trial (p > 0.05). Significant main effects of age, gender, and bolus volume were found (p < 0.05), i.e., elderly adults had longer SAD than young and middle-aged adults; women had longer SAD than men; and SAD increased as bolus volume increased. With respect to saliva swallows, a significant interaction of age by gender was found (p < 0.05), i.e., males exhibited a decrease in SAD with increasing age while females exhibited an increase in SAD with increasing age. Concerning swallow/respiratory phase relationships, the pattern of exhale-swallow-exhale was evident during 62% of participants' swallows. Furthermore, age, gender, or bolus volume did not predict the pattern of exhale-swallow-exhale (p > 0.05).

Age Factors↗
PubMed2000

Learning about the dynamic swallowing process using an interactive multimedia program.

The management of dysphagia is the largest recognized subspecialty in the field of speech-language pathology. Practicing speech-language pathologists require a comprehensive theoretical and functional knowledge base to underpin the safe and effective management of people with dysphagia. Students need to develop an understanding of the normal integrated swallow and how it can be affected to appreciate the assessment or treatment of dysphagia. Although students are well motivated to learn this material, assimilating knowledge of the dynamic nature of the swallow has typically been problematic because of its complex character. The limitations of currently available teaching resources have been addressed by the production of an interactive multimedia program that includes integrated presentation of text, graphics, voice-overs, and video and animation sequences to highlight various aspects of the swallowing process. Students can selectively manipulate parts of this process to understand the normal swallow and to simulate different aspects of dysfunction and the consequent effects on swallow safety and efficiency. Feedback from students, faculty, and experts has demonstrated that The Dynamic Swallow would be a valued tool in the teaching of dysphagia.

CD-ROM↗
PubMed2005

Pediatric FEESST: fiberoptic endoscopic evaluation of swallowing with sensory testing.

Fiberoptic endoscopic evaluation of swallowing (FEES) was developed as an adjunct to the videofluoroscopic swallowing study and clinical examination of swallowing function in the adult. The sensory testing aspect of fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) utilizes an air pulse stimulus of mechanoreceptors within the larynx. The study can be performed safely in children as young as premature infants and in adults. Adequate levels of cooperation can be obtained in nearly all children requiring FEESST. No cases of laryngospasm or respiratory compromise have been encountered. FEESST was initially applied to patients with dysphagia. It is now used in the study of the effects of gastroesophageal reflux on the larynx and swallowing function. The extent of pooled secretions in the hypopharynx can be used as a surrogate measure of laryngopharyngeal sensory testing. When patients managed by FEESST were compared with patients managed by videofluoroscopic swallow studies, there were no statistical differences in the rates of pneumonia or pneumonia-free interval. A learning curve is present for the operator, but with basic endoscopic skills, FEESST is a skill within the scope of practice of most pediatric endoscopists.

Child↗
PubMed1993

Location and axonal projection of one type of swallowing interneurons in cat medulla.

Extracellular recordings were made from a type of relay neurons of the superior laryngeal nerve (SLN) afferents in the vicinity of the retrofacial nucleus (RFN) in either pentobarbitone-anesthetized or unanesthetized and decerebrate cats, which were paralyzed and artificially ventilated. A total of 26 neurons that could be activated both orthodromically by electrical stimulation of the SLN and antidromically by stimulation of the brainstem were analyzed. All 26 neurons were activated from the ipsilateral SLN and 13 were activated from the contralateral SLN with mean latencies of 7.7 ms and 11.4 ms, respectively. The majority of these neurons were located in the parvocellular reticular formation dorsomedial to the RFN and to the rostral part of the nucleus ambiguus (AMB). Antidromic stimulation of the medulla showed that 22 of the 26 neurons projected to the hypoglossal nucleus (HYP) and 19 neurons tested projected to the AMB. Of these, 15 neurons projected to both the HYP and AMB and two projected to the lateral reticular nucleus as well. Seventeen neurons were tested for their behavior during fictive swallowing which was elicited by continual electrical stimulation of the SLN and monitored by the activity of the hypoglossal nerve. Twelve neurons showed brief (100-200 ms) burst firing at the onset of swallowing; the firing of the other 5 neurons were suppressed during swallowing. Both the swallowing-active and swallowing-inactive neurons projected to the HYP and AMB. Thus, the SLN relay neurons in the vicinity of the RFN might participate in the early stage of SLN-induced swallowing by integrating inputs from SLN afferents.

Animals↗
PubMed1995

Modulation of esophageal responses to magnetic stimulation of the human brain by swallowing and by vagal stimulation.

BACKGROUND & AIMS: Although magnetic stimulation of the human cerebral cortex activates corticoesophageal pathways, it is not known whether these pathways are mediated via brain stem neurons activated during swallowing and by vagal afferents. The aim of this study was to determine the effect of swallowing and vagal stimulation on esophageal electromyographic responses evoked by magnetic stimulation of the human cortex. METHODS: Magnetic stimulation of the cortex was performed in 7 subjects at variable intervals after swallows and at intervals ranging from 10 to 200 milliseconds after vagal stimulation in 5 subjects. RESULTS: Between swallows, cortical stimulation induced both early (10.1 +/- 0.5 milliseconds) and late (52.3 +/- 2.3 milliseconds) esophageal electromyographic responses with amplitudes of 66.9 +/- 23.4 microV and 32.9 +/- 7.4 microV, respectively. During swallowing, both responses were facilitated because their latencies decreased (8.9 +/- 0.5 milliseconds and 47.3 +/- 4.8 milliseconds, respectively), whereas their amplitudes increased (203.1 +/- 54 microV and 79.8 +/- 22.5 microV, respectively). Vagal stimulation facilitated the early cortically evoked response. Its latency decreased from 10.2 +/- 0.2 milliseconds to 8 +/- 0.2 milliseconds, whereas its amplitude increased from 145.1 +/- 44 microV to 230.5 +/- 41.6 microV. CONCLUSIONS: Corticoesophageal pathways activated by magnetic stimulation of the human cortex share the same population of brain stem motor neurons to the upper esophagus that are activated during swallowing and vagal stimulation.

Adult↗
PubMed1995

The application of color Doppler technology to the study of fetal swallowing.

OBJECTIVE: To investigate the mechanics of fetal swallowing using color Doppler technology. METHODS: The fetal face and a profile were imaged sagitally in ten fetuses at 36-41 weeks' gestation. Color-flow Doppler signals were superimposed on each gray-scale image to assess the direction and location of amniotic fluid (AF) flow with respect to anatomic structures of the fetal upper gastrointestinal and respiratory tracts during the act of swallowing. Further analysis of fetal swallowing movements was performed by a review of the ultrasonography videotapes at a slow speed. RESULTS: An initial stage of fetal swallowing was characterized by two to six sucking movements and the introduction of an AF bolus into the oral cavity. The soft palate superiorly and the tongue posteriorly and inferiorly obstructed the further flow of AF. The final stage of swallowing was characterized by low-frequency tongue movements, upward laryngeal and epiglottic movements, and narrowing of the lumen of the pharynx, directing the fluid bolus caudally. However, some AF was directed into the nasopharynx as well as the trachea. CONCLUSION: The swallowing pattern in the term fetus differs from that in the infant and adult, in that the oral and pharyngeal phases appear to be less completely developed.

Deglutition↗
PubMed1994

The coordination of rhythmical drinking behavior with swallowing in rabbits.

To analyze the relationship between swallowing and rhythmical licking movement, jaw movement trajectories and muscle activities were recorded during water drinking in freely behaving rabbits. Three types of swallows were identified based on the configurations in thyrohyoid burst with the cycle phases. They were distinguished by whether the burst stayed in the opening phase; whether it continued over the opening phase until the closing phase; and whether it began in the closing phase and ended in the opening phase. The occurrence frequencies were 66%, 20%, and 14%, respectively, for the three types. The duration of the opening phase and burst durations in the jaw opening muscles in swallowing cycles were longer than those in licking cycles regardless when the swallow occurred. However, there were small influences of the thyrohyoid burst on a duration of the closing phase. The results suggest that during licking and swallowing, the digastric muscle may mainly work as a jaw opening-related muscle, and the mylohyoid muscle may work as both a jaw opening-related muscle and a swallowing-related muscle.

Animals↗