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PubMed1996

The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration.

This study retrospectively investigated the value of both endoscopically visible oropharyngeal secretions in the hypopharynx and swallowing frequency in the prediction of aspiration of food and liquid. Fiberoptic endoscopic evaluation of swallowing (FEES) was performed on a total of 69 individuals that included hospitalized elderly, nonhospitalized elderly, and young normal subjects. A four-level rating scale for determining the severity of accumulated oropharyngeal secretions was developed and employed to rate subjects prior to the presentation of food or liquid during the FEES. Spontaneous dry swallows were also counted during the observation period of the FEES. It was found that the accumulation of endoscopically visible oropharyngeal secretions located within the laryngeal vestibule was highly predictive of aspiration of food or liquid. There were significantly fewer spontaneous swallows in hospitalized subjects when compared with nonhospitalized subjects. There was also a significant decrease in the frequency of spontaneous swallows in aspirating hospitalized subjects when compared with nonaspirating hospitalized subjects. Results are discussed in terms of integrating this information with clinical bedside examination techniques.

Aged↗
PubMed1998

The palatal shape of upper removable appliances. Influence on the tongue position in swallowing.

In a clinical-experimental study the influence of variations in the palatal shape of upper removable appliances upon tongue position during swallowing was investigated. During a clinical examination of 35 dental students displaying a physiological swallowing pattern, the tongue position during swallowing was recorded by palatography on an individually adapted upper plate. During swallowing with a roughened plate with an individual palatal shape and an imitated palatal papilla, the tongue position was significantly more posterior than with a highly polished, unstructured plate. The number of students displaying a visceral swallowing pattern was significantly smaller with a roughened plate with palatal folds and papilla then with a polished, smooth appliance. A roughened, individually shaped appliance with palatal folds and palatal papilla should therefore be used after myofunctional therapy and in cases where disturbance of tongue function by the appliance is not desirable.

Adult↗
PubMed1985

Adaptation, compensation, and decompensation of the pharyngeal swallow.

Under normal circumstances, the act of swallowing adjusts to varying demands of different bolus characteristics and different head and neck postures. When the swallowing mechanism is impaired by disease, adjustment is essential to compensate for the impairment and allow swallowing. Evidence of adjustment can be demonstrated by cineradiography which provides important clues to the presence of underlying disease. When adjustment to disease is inadequate, swallowing decompensates. In this case, gross changes in swallowing performance are evident from clinical evaluation and cineradiography.

Adaptation, Physiological↗
PubMed1995

Spontaneous swallowing rate and emotional state. Possible mechanism for stress-related gastrointestinal disorders.

Excessive spontaneous swallowing has been associated with a variety of common gastrointestinal symptoms including abdominal pain, heartburn, and bloating and may contribute to disorders such as hiatus hernia, duodenal ulcer, and irritable bowel syndrome. The present study investigated the hypothesis that changes in emotional state alter spontaneous swallowing rate. Subjects were 38 generally healthy undergraduates assigned to either a pleasant low arousal, neutral, or aversive high arousal condition. Each experimental session was divided into 30-min baseline and arousal manipulation periods. Spontaneous swallowing rate increased significantly with emotional arousal: for low, neutral, and high arousal groups, means were 7.9 +/- 1.9 (SE), 15.8 +/- 2.4, and 23.7 +/- 3.6 swallows/30 min, respectively. Other physiological and self-report measures, used to check the effectiveness of the arousal manipulation, varied appropriately with experimental procedures. These results indicate that changes in emotional state alter spontaneous swallowing rate in generally healthy individuals. Further research with patients is needed to establish whether stress-induced increases in swallowing rate produce or exacerbate clinically significant gastrointestinal symptomatology.

Adolescent↗
PubMed1993

[Video-supported dynamic B-mode sonography of tongue function during swallowing].

A dynamic B-mode ultrasound technique supported by video recording was employed on 51 patients between the ages of six and 45 years for the purpose of imaging the tongue at rest and in motion during swallowing. All patients either in their case histories or at clinical examination demonstrated orofacial dysfunction of the tongue or an abnormal oral phase during swallowing. The ultrasound sequences of a 5 MHz sector scanner (100 degrees, 30 images/sec) were videotaped for the purpose of analyzing the sagittal and vertical movement components during swallowing. The sagittal sector scan revealed a visceral swallowing pattern in 21 patients. Noticeably often patients with an Angle class III malocclusion also displayed an abnormal swallowing pattern. Ultrasound scanning in the coronal and sagittal plane is a noninvasive imaging technique free of the biological risks associated with radiation. The dynamic ultrasound technique may be employed for early detection and diagnosis of tongue discoordinations and is especially to be recommended for the objective imaging and identification of tongue thrust in orthodontic patients.

Adolescent↗
PubMed1993

Swallowing therapy in patients with neurological disorders causing cricopharyngeal dysfunction.

The results of swallowing therapy in 28 patients with neurological disorders causing cricopharyngeal (CP) dysfunction are reported. Variables described include the type of swallowing disorder, type and degree of aspiration, and therapeutic strategies. Patients were monitored by cineradiography before, during, and after therapy. Success of therapy was defined by progress in type, ease and safety of feeding, and range of diet. As an example, a case of an unusually severe disorder of a CP opening subsequent to brainstem meningoencephalitis is described. The bedside clinical evaluation, otolaryngologic findings, and radiographic studies helped determine an individualized program of swallowing therapy. Therapy goals, direct and indirect therapeutic strategies, and the treatment outcome are presented. Ninety percent of patients with CP dysfunction improved with swallowing therapy, 65% by objective and 25% by subjective criteria. We conclude that in neurological patients with CP, dysfunction can effectively be treated with swallowing therapy and that surgical approaches to CP dysfunction should be deferred pending the outcome of conservative management.

Adult↗
PubMed1989

Relationship between saliva production and oropharyngeal swallow in healthy, different-aged adults.

We have evaluated the possible relationship between major salivary gland fluid secretion rate and characteristics of the oral phase of swallowing in 35 different-aged, healthy men and women. All subjects displayed normal function of the parotid and submandibular glands and oral swallow patterns on ultrasound evaluation that were comparable to previous reports. In this study group we found no significant relationships between salivary flow rates (unstimulated, stimulated) and any oral swallow measure. Evidence of a subtle, age-related oral motor change (multiple hyoid and tongue gestures) was seen but swallow duration times did not show a linear relationship to age. This study demonstrates that healthy individuals, despite a wide range in their salivary gland fluid secretory capacity, are generally similar in the characteristics of their oropharyngeal swallow.

Adult↗
PubMed1992

Multiple swallows and piecemeal deglutition; observations from normal adults and patients with head and neck cancer.

The incidence of multiple swallows for liquid and paste, and the time delay between multiple swallows, was determined from videofluoroscopic records of modified barium swallow tests. In a comparison of liquid and paste, the overall incidence of multiple swallows did not differ, for either patients with head and neck cancer or normal controls. However, for liquid swallows the incidence in patients with cancer was abnormally high, predominantly in patients with pharyngeal cancer.

Adult↗
PubMed1992

Periventricular white matter changes and oropharyngeal swallowing in normal individuals.

Cranial magnetic resonance imaging (MRI) has revealed patchy periventricular white matter lesions or "unidentified bright objects" (UBOs) in otherwise neurologically intact individuals. Quantitative videofluoroscopic swallowing evaluations and cranial MRI examinations were studied in 49 neurologically normal volunteers (ages 43 to 79 years). Total swallowing duration (TSD) and its subcomponents of oral transit duration (OTD), stage transition duration (STD), and pharyngeal response duration were measured for liquid and semisolid swallows. MRIs were graded from 0, or no UBOs, to 3, or multiple and confluent lesions. The effect of the presence of UBOs on swallowing durational measures and risk factors was analyzed with age differences accounted for statistically (ANCOVA). TSD and OTD for semisolids were significantly differentiated by MRI score (P less than 0.009 and P less than 0.047, respectively). That is, a demonstrable effect was found for an increased number of UBOs on duration of oropharyngeal swallowing in normal individuals.

Adult↗
PubMed1992

Sounds of swallowing following total laryngectomy.

Accelerometer transduced sounds of swallowing in total laryngectomees did not show acoustical differences for liquid vs paste swallows, as are found in normals. Compared with normal swallows, tongue propulsion of the bolus in laryngectomee swallows occurred closer in time to a distinctive spectral change associated with bolus flow into the esophagus. Interpretation stressed the lack of mechanical traction from laryngeal elevation contributing to pharyngoesophageal sphincter opening, and the increased role of tongue propulsion in laryngectomee swallows.

Adult↗
PubMed1994

Pharyngoesophageal pressure in patients with swallowing disorders.

We developed and tested a pressure transducer to correctly determine swallowing pressure at different sites in the pharynx. In normal individuals three pressure peaks were obtained in the mesopharynx, hypopharynx and cervical esophagus, respectively. A patient with central dysphagia demonstrated markedly low mesopharyngeal and hypopharyngeal swallowing pressure. One tongue cancer patient who had undergone right hemiglossectomy, including partial resection of the root of the tongue and bilateral superior neck dissection, had markedly low swallowing pressure in the mesopharynx and vallecula area. Another supraglottic cancer patient treated by supraglottic horizontal partial laryngectomy showed extremely low swallowing pressure in the supraglottic area. Based on our findings, we suggest that measurements using a pressure transducer such as the one described here should be used in combination with radiographic study to diagnose swallowing anomalies correctly. Data obtained with the pressure transducer will allow the clinician to identify the site responsible for postoperative dysphagia as well as its severity, and facilitate planning of reconstructive surgery when required.

Adult↗
PubMed2003

Clinical implications of gastroesophageal reflux disease and swallowing dysfunction in COPD.

The intimate anatomical and physiologic relationship between the upper airway and esophagus consists of complex interactions between various muscles and nerves with both voluntary and involuntary patterns of control. Alterations in this harmonic relationship can lead to swallowing abnormalities ranging from dysphagia to gross aspiration, gastroesophageal reflux disease (GERD) and chronic cough. There is a paucity of data regarding pathologic alterations in the upper airway-esophageal relationship in patients with COPD. The association between GERD and respiratory symptoms is well recognized in the setting of asthma; however, the nature of this relationship remains controversial. The association of GERD and COPD is even less clear. A review of the limited data on GERD and swallowing abnormalities in patients with COPD indicate that prevalence of GERD and esophageal disorders in patients with COPD is higher than in the normal population. However, its contribution to respiratory symptoms, bronchodilator use and pulmonary function in patients with COPD remains unknown. Although dysphagia and swallowing dysfunction on videofluoroscopic swallow evaluation are common in patients with COPD, their role as exacerbators of COPD remains to be elucidated. Further clinical research is necessary to evaluate the role of GERD and swallowing dysfunction in both stable and acute exacerbation of COPD.

Adult↗
PubMed1998

Swallowing problems in the nursing home: a novel training response.

Various studies suggest that between 50% and 75% of nursing home residents have some difficulty in swallowing. Some of these residents are assessed and treated by speech pathologists, but many are managed by nursing staff without specialist input. A training program called Swallowing ... on a Plate (SOAP) has been developed by the Centre for Education and Research on Ageing and the Inner West Geriatrics and Rehabilitation Service to help address swallowing-related problems in local nursing homes (Inner West of Sydney, Australia). The training program teaches nursing staff how to identify, assess, and manage swallowing problems, including making appropriate referrals. Several new instruments were developed specifically for this program including two assessment checklists, a set of management guidelines, and a swallowing care plan. Evaluation of the program--including 3 months follow-up--showed it to be highly successful. A stand-alone training resource has been produced for wide distribution to help staff implement the program as a permanent aspect of their nursing care. This paper describes the development, content, presentation, resource, and evaluation of the above program.

Aged↗
PubMed1999

Temporal and durational patterns associating respiration and swallowing.

This study obtained initial normative data on the temporal coordination of respiration and swallowing events in 12 young adults using a first-generation Respirodeglutometer. In addition, direction of airflow before and after deglutive apnea was obtained. Three swallows of two viscosities of bolus material were performed by each subject, yielding a total of 72 swallows. Qualitative and quanitative analyses were performed. Time of onset of submental surface electromyography and time of laryngeal movement were found to differ between males and females. Males began submental muscle contraction before females and laryngeal movement after females. Duration of deglutition apnea for all swallows was 0.75 +/- 0.14 sec. Expiration occurred before the deglutition apnea 93% of the time and after the deglutition apnea 100% of the time. A modal pattern of events obtained with the Respirodeglutometer was present in 42% of the swallows, and an additional 47% had only one event differ from that order.

Acoustics↗
PubMed1999

Swallowing abnormalities after acute stroke: A case control study.

Dysphagia is a common and potentially fatal complication of acute stroke. However, the underlying pathophysiology, especially the relative importance of motor and sensory dysfunction, remains controversial. We conducted a case control study of 23 acute stroke patients (mean age = 72 yr) at a median of 6 days post-stroke and 15 healthy controls (mean age = 76 yr). We used novel methods to assess swallowing in detail, including a timed videoendoscopic swallow study and oral sensory threshold testing using electrical stimulation. Vocal cord mobility and voluntary pharyngeal motor activity were impaired in the stroke group compared with the controls (p = 0.01 and 0.03). There was a delay during swallowing in the time to onset of epliglottic tilt in the stroke group, particularly for semisolids (p = 0.02) and solids (p = 0.01), consistent with a delay in initiation of the swallow. Sensory thresholds were not increased in the stroke group compared with controls. We conclude that pharyngeal motor dysfunction and a delay in swallow initiation are common after acute stroke. Vocal cord mobility is reduced, and this may result in reduced airway protection. We found no evidence to support the hypothesis that oropharyngeal sensory dysfunction is common after acute stroke.

Acute Disease↗
PubMed1996

[Value of parametric esophageal scintigraphy with multi-swallow technique in comparison with esophageal manometry].

Diagnosis of esophageal motility disorders is difficult due to the large physiologic variability of bolus transport. With the help of a parametric multiple swallow technique (introduced by Tatsch), using "condensed images" of each single swallow action before creating a "mean image" of six swallows, this problem can be solved. For testing this relatively new method, 12 patients underwent 16 pairs of parametric esophageal scintigraphy and esophageal manometry. This collective of patients consisted of 4 with achalasia and secondary hypomobility of the tubular esophagus, 7 with unspecific esophageal dysfunction confirmed by manometry and 1 with clinical dysphagia and normal status in manometry. Fourteen of 15 pathological manometric findings could be confirmed with parametric scintigraphy. Esophageal manometry was false negative in one case and esophageal scintigraphy in another one case. The calculated emptying rates 10 and 12 s after beginning of swallowing are (mean +/- SD) 56 +/- 34% and 60 +/- 34% respectively for solid meal and 54 +/- 25% 57 +/- 22% respectively for liquid meal. Of 60 emptying rates, 48 are in the pathologic range of less than 80%. As expected, no significant difference was found between emptying rates after 10 and 12 s (two-tailed matched pairs t-test. 5% significance level). In conclusion, parametric esophageal multiple swallow scintigraphy has been proven to be a non-invasive and sensitive tool for pre- and posttherapeutic care of patients with esophageal motility disorders. It should be mentioned that esophageal scintigraphy can give additional information in some cases of normal esophageal manometry.

Administration, Oral↗
PubMed2001

Parallel cortical networks for volitional control of swallowing in humans.

A number of studies have demonstrated the involvement of parallel networks in the control of voluntary sequential motor procedures. We sought to determine whether a parallel network organization may be found for complex, sequentially based motor systems that are the product of both voluntary and automatic control processes. Specifically, we sought to determine whether the cortical organizational scheme for voluntary repetitive swallowing in adult humans is characterized by a hierarchical dual-projection model or by modules organized into parallel systems. We utilized functional magnetic resonance imaging (fMRI) to investigate cortical function during normal swallowing tasks in eight healthy human adults. Subjects performed both dry (saliva) and bolus (3 ml/bolus of water) swallows. Activation during swallowing tasks localized to sensorimotor areas (M1, S1, and SMA), S2, premotor cortex, posterior parietal cortex, cingulate gyrus, inferior frontal gyrus, the cerebellum, the insular cortex, auditory cortex, corpus callosum, and the basal ganglia and thalamus. Principal components analysis (PCA) of these regions revealed five functional clusters or modules: (1) sensorimotor areas and cingulate gyrus; (2) inferior frontal gyrus, S2, corpus callosum, basal ganglia and thalamus; (3) premotor cortex and posterior parietal cortex; (4) cerebellum; and (5) insula. Analysis of the functional relationship between these areas demonstrated two parallel loops defined by connections to either the cerebellum or insula and connected through the sensorimotor-cingulate module. Path analysis was performed to test the hypothesis of modules organized into parallel loops versus a hierarchical dual-projection model consisting of two separate, singular hierarchical serial pathways from the sensorimotor cortex or insula to the thalamus. These results support the model of modules organized into parallel loops (P=0.8), but not the hierarchical dual-projection model (P<0.0001). Organization of the control of voluntary repetitive swallowing into two parallel systems may confer the ability to effectively coordinate and integrate this highly complex sequentially based motor behavior.

Adult↗
PubMed2007

Radiation doses to children during modified barium swallow studies.

BACKGROUND: There are minimal data on radiation doses to infants and children undergoing a modified barium swallow (MBS) study. OBJECTIVE: To document screening times, dose area product (DAP) and effective doses to children undergoing MBS and to determine factors associated with increased screening times and effective dose. MATERIALS AND METHODS: Fluoroscopic data (screening time, DAP, kVp) for 90 consecutive MBS studies using pulse fluoroscopy were prospectively recorded; effective dose was calculated and data were analyzed for effects of behavior, number of swallow presentations, swallowing dysfunction and medical problems. RESULTS: Mean effective dose for the entire group was 0.0826 +/- 0.0544 mSv, screening time 2.48 +/- 0.81 min, and DAP 28.79 +/- 41.72 cGy cm2. Significant differences were found across three age groups ( 1.0-3.0 and >3.0 years) for effective dose (mean 0.1188, 0.0651 and 0.0529 mSv, respectively; P < 0.001), but not for screening time or DAP. Effective dose was correlated with screening time (P = 0.007), DAP (P < 0.001), number of swallow presentations (P = 0.007), lower age (P = 0.017), female gender (P = 0.004), and height (P < 0.001). Screening time was correlated with total number of swallow presentations (P < 0.001) and DAP (P < 0.001). CONCLUSION: Screening times, DAP, effective dose, and child and procedural factors associated with higher effective doses are presented for children undergoing MBS studies.

Administration, Oral↗