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PubMed2000

[The aspiration and swallowing of foreign bodies. The management of the aspiration or swallowing of foreign bodies during dental treatment].

The purpose of this article is to draw attention to the possible complications of foreign body ingestion or aspiration associated with dental treatment, especially oral implant treatment. A guide for the management of swallowed or inhaled objects is given. When the object cannot be coughed out, then it is mandatory to take frontal and lateral chest roentgenograms to identify the object's position in the intestinal system or in the tracheobronchial tree. In case of ingestion, attempts should be made to recover the foreign object by esophagoscopy. Aspirated foreign bodies should be removed within 24 hours. Acute obstruction can be life threatening and delaying the removal of foreign objects may make a bronchoscopy technically more difficult. The clinician must be aware of the complications involved in accidentally inhaling or ingesting foreign bodies during dental treatment. Patients at greater risk of swallowing or aspirating foreign objects need to be identified and extra preventive steps must be taken to avoid such complications.

Aged↗
PubMed1988

[Syncope in the act of swallowing (swallowing syncope)].

In a 30-year-old female patient with recurrent syncope during swallowing, intermittent complete AV-block was documented as the underlying mechanism. This phenomenon could be provoked by inflating a balloon positioned in the lower esophagus. The His-bundle electrocardiogram, recorded simultaneously, showed a progressive increase of the normal AH-interval, up to complete block distal to the A-wave. Atropine prevented induction of the block. After implantation of a VVI pacemaker, the symptoms disappeared completely. This very rare phenomenon of swallowing syncope is probably due to a pathologic vago-vagal reflex.

Adult↗
PubMed1995

Respiratory phase resetting and airflow changes induced by swallowing in humans.

1. Relationships between the timing of respiration and deglutition were studied in thirty awake healthy subjects at rest. Deglutition was monitored by submental electromyography, pharyngeal manometry and videofluoroscopy. Respiration was recorded by measurement of oronasal airflow and chest wall movement. Three types of deglutition were studied: injected bolus swallows, spontaneous swallows, and visually cued swallows of boluses previously placed in the mouth. 2. The effect of each swallow on respiratory rhythm was characterized by measurement of cophase, defined as the interval between the onset of deglutitive submental EMG activity to the onset of subsequent rescheduled inspirations. Cophase was determined for swallows initiated at different phases of the respiratory cycle. In all subjects deglutition caused phase resetting of respiratory rhythm. Cophase was largest for swallows initiated near the the inspiratory-expiratory (E-I) transition and smallest for swallows initiated near the expiratory-inspiratory (E-I) transition. The pattern of respiratory resetting by deglutition was topologically classified as type 0. This pattern was shown for swallows induced by bolus injection or visual cue, and for spontaneous swallows. 3. The incidence of spontaneous deglutition was influenced by the position of the swallow in the respiratory cycle. Few spontaneous swallows were initiated near the E-I transition whereas most occurred from late inspiration to mid-expiration. 4. Deglutition caused an abrupt decrease in airflow leading to an interval of apnoea, followed by a period of expiration. The duration of deglutition apnoea for spontaneous swallows was shorter than that for 5 ml bolus swallows, and was unaffected by the respiratory phase of swallow initiation. The period of expiration after swallowing was longest for swallows initiated at the I-E transition, and shortest for E-I swallows. 5. The intervals between bolus injection and the onset of deglutition apnoea, and the timing of swallowing events, were not significantly altered by the phase in the respiratory cycle at which swallowing was exhibited. 6. To quantify the relationship between bolus flow and respiration, we determined the latencies between cessation of inspiratory airflow and arrival of the bolus at the larynx (alpha), and between laryngeal bolus departure and resumption of inspiratory airflow (delta). Both values were dependent upon the respiratory phase of swallowing. The lowest values for alpha and delta were found for early-inspiratory and late-expiratory swallows, respectively. 7. We conclude that swallowing causes respiratory phase resetting with a pattern that is characteristic of the strong perturbations of an attractor-cycle oscillator.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

Acoustic adaptations for parent-offspring recognition in swallows.

We have used field and laboratory studies to investigate acoustic adaptations for parent-offspring recognition in two closely related pairs of swallows: (a) bank swallow (Riparia riparia) and northern rough-winged swallow (Stelgidopteryx serripennis), and (b) cliff swallow (Hirundo pyrrhonota) and barn swallow (Hirundo rustica). Cross-fostering and playback experiments show that bank swallow and cliff swallow parents recognize their offspring by voice while rough-winged swallow and barn swallow parents do not. We argue that this species difference is due to an evolutionary history of strong selection for recognition in bank swallows and cliff swallows, which live in large, dense colonies, and of weak or no selection for recognition in rough-winged swallows and barn swallows, which live solitarily or in small groups. We consider two possible acoustic adaptations which may underlie the observed species difference. First, the "signature" calls of cliff swallow and bank swallow chicks appear to be more individually distinctive than the homologous calls of rough-winged swallows and barn swallows. This conclusion is supported by a sonographic analysis of among- and within-individual call variation: The information content of bank swallow and cliff swallow calls is considerably greater than that of rough-winged swallow or barn swallow calls. We also discuss our more recent work on the hypothesis that the colonial swallow species are better able to discriminate these sorts of auditory stimuli. We conclude with the caution that auditory specializations may be unnecessary given the signature call adaptation and the general capabilities of the avian ear.

Animal Communication↗
PubMed1995

Modification of mastication and respiration during swallowing in the adult human.

1. The normal interactions between respiration, mastication, and swallowing were studied in seated adult humans. Respiratory movements and movements of the larynx were recorded with mercury-elastic strain gauges placed around the rib cage and neck. A rigid body containing infrared-emitting diodes (IREDs) was attached to the forehead, and a single IRED was applied to the chin. Jaw and head movements were transduced using the OPTOTRAK spatial motion analysis system. Recordings were made before, during, and after the mastication of pieces of carrot. 2. Movements of the larynx were used as a marker for swallowing. Measurements were made of the duration of masticatory and respiratory cycles, and the phase relationship between the two rhythms was determined. Deviations in masticatory and respiratory movements during swallowing were detected; the phases of the masticatory and respiratory cycles in which the deviations occurred were determined, and the interval between each deviation and the swallowing marker was calculated. 3. Three characteristic swallowing patterns were observed: interposed, terminal, and spontaneous. Interposed swallows occurred within a masticatory sequence, terminal swallows ended the sequence, and spontaneous swallows occurred sporadically between masticatory sequences. 4. Results revealed that mastication could have a profound effect on the respiratory rhythm in some subjects. One subject, whose data were excluded from further analyses, became apneic for a long period, followed by short and shallow breaths near the end of the masticatory sequence. In most subjects, respiratory rate increased during mastication and then dropped below baseline as soon as mastication ended. The end-inspiration diameter of the rib cage tended to decrease in the preswallow period and increase postmastication relative to baseline. 5. There was a weak but significant tendency for inspiration to begin during the jaw opening phase of mastication, but phase coupling did not become stronger as swallowing was approached. 6. Deviations in respiration during swallowing occurred during the late expiratory phase of the breathing cycle. Swallows within a masticatory sequence occurred most frequently during the early opening phase of the masticatory cycle, and terminal swallows occurred after the end of the sequence with the mandible in the resting, postural position. Swallowing temporarily reset both the masticatory and respiratory rhythms. Most swallows prolonged the duration of one or two respiratory cycles, however; swallows were often repetitive, and in some subjects two or three swallows fell within a single respiratory cycle, prolonging it for several seconds. 7. A tight temporal relationship was observed between deviations in respiration and the swallowing marker: all deviations occurred before or coincident with the marker. The time of deviations in mastication relative to the swallowing marker depended on swallow type. There was no link between the start of pauses in the two rhythms, suggesting that the commands from the swallowing central pattern generator to the other two pattern generators are independent. 8. We suggest that disordered coordination of mastication and swallowing with respiration may cause prolonged apnea in susceptible individuals.

Adult↗
PubMed2003

Sensory regulation of swallowing and airway protection: a role for the internal superior laryngeal nerve in humans.

During swallowing, the airway is protected from aspiration of ingested material by brief closure of the larynx and cessation of breathing. Mechanoreceptors innervated by the internal branch of the superior laryngeal nerve (ISLN) are activated by swallowing, and connect to central neurones that generate swallowing, laryngeal closure and respiratory rhythm. This study was designed to evaluate the hypothesis that the ISLN afferent signal is necessary for normal deglutition and airway protection in humans. In 21 healthy adults, we recorded submental electromyograms, videofluoroscopic images of the upper airway, oronasal airflow and respiratory inductance plethysmography. In six subjects we also recorded pressures in the hypopharynx and upper oesophagus. We analysed swallows that followed a brief infusion (4-5 ml) of liquid barium onto the tongue, or a sip (1-18 ml) from a cup. In 16 subjects, the ISLN was anaesthetised by transcutaneous injection of bupivacaine into the paraglottic compartment. Saline injections using the identical procedure were performed in six subjects. Endoscopy was used to evaluate upper airway anatomy, to confirm ISLN anaesthesia, and to visualise vocal cord movement and laryngeal closure. Comparisons of swallowing and breathing were made within subjects (anaesthetic or saline injection vs. control, i.e. no injection) and between subjects (anaesthetic injection vs. saline injection). In the non-anaesthetised condition (saline injection, 174 swallows in six subjects; no injection, 522 swallows in 20 subjects), laryngeal penetration during swallowing was rare (1.4 %) and tracheal aspiration was never observed. During ISLN anaesthesia (16 subjects, 396 swallows), all subjects experienced effortful swallowing and an illusory globus sensation in the throat, and 15 subjects exhibited penetration of fluid into the larynx during swallowing. The incidence of laryngeal penetration in the anaesthetised condition was 43 % (P < 0.01, compared with either saline or no injection) and of these penetrations, 56 % led to tracheal aspiration (without adverse effects). We further analysed the swallow cycle to evaluate the mechanism(s) by which fluid entered the larynx. Laryngeal penetration was not caused by premature spillage of oral fluid into the hypopharynx, delayed clearance of fluid from the hypopharynx, or excessive hypopharyngeal pressure generated by swallowing. Furthermore, there was no impairment in the ability of swallowing to halt respiratory airflow during the period of pharyngeal bolus flow. Rather, our observations suggest that loss of airway protection was due to incomplete closure of the larynx during the pharyngeal phase of swallowing. In contrast to the insufficient closure during swallowing, laryngeal closure was robust during voluntary challenges with the Valsalva, Müller and cough manoeuvres under ISLN anaesthesia. We suggest that an afferent signal arising from the ISLN receptor field is necessary for normal deglutition, especially for providing feedback to central neural circuits that facilitate laryngeal closure during swallowing. The ISLN afferent signal is not essential for initiating and sequencing the swallow cycle, for co-ordinating swallowing with breathing, or for closing the larynx during voluntary manoeuvres.

Adult↗