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PubMed1983

The volume of a swallow: correlation of deglutition with patient and container parameters.

The study purpose was to evaluate the relationships between average volume of a swallow (AVS) and age, height, weight, sex, and container-opening diameter (COD) to confirm and expand the work of Jones and Work. Forty-five males and 50 females between two and 18 years of age were studied. Each subject drank five swallows from each of four containers. AVS for each subject under each condition was calculated and the joint relationship with the independent variables analyzed by multiple regression. Age, height, and weight were highly intercorrelated, and each had similar correlations with AVS. COD was important; between 24 and 90 months of age, swallows from the 6.5 cm COD had a three- or four-fold larger AVS than swallows from the 1.5 cm COD. Sex differences in AVS were noted in subjects over seven years of age. These findings suggest that determination of the child's age and number of swallows ingested may be useful in estimating the fluid volume ingested and the potential toxicity of an exposure.

Adolescent↗
PubMedDate not supplied

Dynamic reconstruction of the oropharyngeal swallow using computer based animation.

The oropharyngeal swallow was modeled with computer based animation using data from biplane videofluorographic and dynamic CT images of 10 ml liquid swallows of a volunteer subject. Tracings of oropharyngeal structures from synchronized, magnification adjusted, images of the posterior-anterior, lateral, and cross-sectional planes were aligned in three dimensions with graphics animation software. Twenty oropharyngeal configurations were created at 1/15 second intervals to dynamically illustrate the swallow. These three-dimensional reconfigurations could be sequenced into an animation routine. Software analysis of the model permitted quantification of structural movement and intrapharyngeal volume across time. Such analyses can be used to detail both the efficacy of individual functional elements of the swallow as well as global pump function. It is hoped that modeling the oropharyngeal swallow will be useful to analyze mechanisms of dysphagia and the mechanics of compensatory therapeutic strategies.

Adult↗
PubMedDate not supplied

Long-term voice and swallowing modifications after supracricoid laryngectomy: objective, subjective, and self-assessment data.

PURPOSE: The supracricoid laryngectomies (SCLs) are conservative surgical techniques for the treatment of selected laryngeal carcinomas. The advantage of SCL is that a permanent tracheostoma is not required, thus, maintaining the principal laryngeal functions. The aim of the study is to report objective, subjective, and self-assessment long-term results of voice and swallowing in a large group of patients who underwent SCL at least 2 years before this study was undertaken. METHODS: Twenty male subjects who underwent SCL with a mean age of 71 years (range, 51-82) were involved in a retrospective study on swallowing and vocal function. Videoendoscopic ratings were taken of neoglottic vibration patterns and bolus transit. The maximum phonation time and the syllable diadochokinesis were measured. Spectrograms were recorded. Voices were perceptually rated using the Grade, Instability, Roughness, Breathiness, Asthenicity, Strain (GIRBAS) scale. All of the subjects completed a self-assessment questionnaire for both voice and swallowing. RESULTS: Videoendoscopic ratings showed moderate to severe impairment of neoglottal vibration, whereas bolus transit appeared only mildly impaired. The mean values of the GIRBAS scale were 2.4, 2.6, 2.4, 0.8, 0.5, and 0.8. The mean maximum phonation time was 7.5 seconds, whereas the mean value of the Yanagihara scale was 3.7 for voice spectrograms. Mean syllable diadochokinesis appeared as 3.3 syllables per second. Voice and swallowing quality of life questionnaires revealed satisfied patients. CONCLUSIONS: Swallowing after SCL was satisfactory; on the contrary, endoscopic, aerodynamic, perceptual, and acoustic data showed a highly dysphonic voice after SCL. However, self-assessment results revealed relatively satisfied speakers on the emotional, physical, and functional levels.

Aged↗
PubMed2004

Characterising the central mechanisms of sensory modulation in human swallowing motor cortex.

OBJECTIVE: Pharyngeal stimulation can induce remarkable increases in the excitability of swallowing motor cortex, which is associated with short-term improvements in swallowing behaviour in dysphagic stroke patients. However, the mechanism by which this input induces cortical change remains unclear. Our aims were to explore the stimulus-induced facilitation of the cortico-bulbar projections to swallowing musculature and examine how input from the pharynx interacts with swallowing motor cortex. METHODS: In 8 healthy subjects, a transcranial magnetic stimulation (TMS) paired-pulse investigation was performed comprising a single conditioning electrical pharyngeal stimulus (pulse width 0.2 ms, 240 V) followed by cortical TMS at inter-stimulus intervals (ISI) of 10-100 ms. Pharyngeal sensory evoked potentials (PSEP) were also measured over the vertex. In 6 subjects whole-brain magnetoencephalography (MEG) was further acquired following pharyngeal stimulation. RESULTS: TMS evoked pharyngeal motor evoked potentials were facilitated by the pharyngeal stimulus at ISI between 50 and 80 ms (Delta mean increase: 47+/-6%, P < 0.05). This correlated with the peak latency of the P1 component of the PSEP (mean 79.6+/-8.5 ms). MEG confirmed that the equivalent P1 peak activities were localised to caudolateral sensory and motor cortices (BA 4, 1, 2). CONCLUSIONS: Facilitation of the cortico-bulbar pathway to pharyngeal stimulation relates to coincident afferent input to sensorimotor cortex. SIGNIFICANCE: These findings have mechanistic importance on how pharyngeal stimulation may increase motor excitability and provide guidance on temporal windows for future manipulations of swallowing motor cortex.

Adult↗
PubMed2006

Movement of the hyoid bone and the epiglottis during swallowing in patients with dysphagia from different etiologies.

PURPOSE: (1) To compare the kinematic motion of the hyoid bone and the epiglottis in healthy controls and a sample of patients with dysphagia of different etiologies, and (2) to evaluate the potential value of kinematic swallowing analysis to differentiate the mechanism of dysphagia. METHODS: We performed two-dimensional video motion analysis of the hyoid bone using videofluoroscopic images in nine controls without any swallowing difficulty, and seven patients with supratentorial stroke, three patients with inflammatory myopathy who showed dysphagia. Main outcome measures were: (1) horizontal and vertical excursion of the hyoid bone, and rotation of the epiglottis, and (2) trajectory of the hyoid bone and epiglottis during swallowing. RESULTS: Horizontal excursion of the hyoid bone and rotation of the epiglottis were reduced in patients with myopathy as compared to control and patients with stroke (P<0.05). Patients with dysphagia showed different patterns as compared to control in trajectory analysis according to their etiology. CONCLUSION: We conclude that extent and pattern of movement of the hyoid bone and the epiglottis during swallowing were different according to etiology of dysphagia, and swallowing motion analysis could be applied to differentiate the mechanism of dysphagia.

Aged↗
PubMed2005

The influence of tracheotomy tubes on the swallowing frequency in neurogenic dysphagia.

OBJECTIVES: To compare the swallowing frequency in patients with neurogenic dysphagia with or without tracheotomy tubes (TT) to assess the underlying mechanisms of dysphagia to improve rehabilitation strategies. STUDY DESIGN AND SETTING: Prospective study, 10 patients (64 +/- 7 years) with neurogenic dysphagia. Glasgow Coma Scale (GCS) less than 8 points, tracheotomy due to the dysphagia 2 weeks before the examination. The swallowing frequency (1 or less over 5 min) was assessed over 5 consecutive days with or without TT. RESULTS: The swallowing frequency increased after removal of the TT. These findings did not influence the GCS or the Coma Remission Scale. Over a 5-day period, the frequency of swallowing was increased. CONCLUSION: TTs decisively influence the swallowing behavior of vegetative patients. This phenomenon could be based on an improved sensitivity under re-established physiological expiration. We strongly favor removing the TT or deflating the cuff of the TT under therapeutic conditions in a rehabilitation therapy setting.

Deglutition↗
PubMed2005

C-fiber blockade influence on non-nutritive swallowing in full-term lambs.

Systemic C-fiber blockade (CFB) has been reported to inhibit induced swallowing in adult guinea pigs. The aim of this study was to investigate the effects of CFB on spontaneous, non-nutritive swallowing (NNS) frequency and NNS-respiration coordination in the neonatal period. Seven CFB lambs and seven control lambs aged 2+/-1 days were chronically instrumented for recording electroencephalogram, eye movements, diaphragm EMG, thyroarytenoid muscle EMG, nasal airflow and electrocardiogram. Polysomnographic recordings were performed in non-sedated lambs, using radiotelemetry transmission. CFB lambs spent more time in active sleep than controls (p=0.02). Frequency of non-nutritive swallowing was not different in CFB and control lambs, whatever the state of alertness. In addition, CFB did not disrupt the overall respiratory-swallowing coordination, inspiratory-related NNS being the most frequent and expiratory-related NNS the least in both CFB and control lambs. Further analyses revealed that CFB had no effect on baseline respiratory and heart rate, and apnea and sigh frequency, whatever the state of alertness. Our results suggest that, in the neonatal period, C-fibers are not involved in NNS frequency and have no influence on the overall respiratory-swallowing coordination.

Animals↗
PubMed2006

The early impact of feeding on infant breathing-swallowing coordination.

This longitudinal study assessed the coordination of nutritive and non-nutritive swallowing with breathing in 10 healthy term infants from birth to 1 year of age. Swallows were classified into five respiratory-phase categories: mid-inspiration (II), mid-expiration (EE), inspiratory-expiratory cusp (IE), expiratory-inspiratory cusp (EI), and mid-pause (P). Breathing-swallowing coordination differed markedly between the two swallowing conditions, especially between 2 weeks and 2 months. Significant condition effects were found in up to four respiratory-phase categories (II, IE, EI, and P). The condition effect was minimal from 9 months with only IE swallow proportions differing between conditions. These data suggest a 'critical period' in infantile neural response to oropharyngeal stimulation during feeding and that the impact of this on infants with neurological and/or respiratory disorders should be further investigated.

Adaptation, Physiological↗
PubMed2002

Effects of reversible bilateral inactivation of face primary motor cortex on mastication and swallowing.

The effects of reversible cold block-induced bilateral inactivation of the face primary motor cortex (face MI) on mastication and swallowing were studied in awake monkeys. A warm or cold alcohol-water solution was pumped through thermodes placed bilaterally on the dura overlying the intracortical microstimulation-defined face MI while the monkey chewed and swallowed food during pre-cool (thermode temperature 37 degrees C), cold block (4 degrees C), and post-cool (37 degrees C) sessions. Vertical and horizontal jaw movements and electromyographic (EMG) activity of several muscles were monitored. Each masticatory sequence was divided into three masticatory phases (i.e. food preparatory, rhythmic chewing, preswallow). The cold block markedly affected the ability of the monkey to carry out mastication although it did not prevent mastication from occurring. The masticatory deficit was characterized by a significant elongation of the total masticatory time, including in particular elongation of the food preparatory phase. The coordination of the jaw- and tongue-muscle activities was severely disrupted during the food preparatory phase. Face MI cold block also significantly affected the duration of some masticatory-related EMG activities and had some limited effects on the temporal relationships of the EMG activities during mastication. Although cold block significantly affected the duration and some EMG parameters of the preswallow phase, it had no significant effect on swallow duration or the EMG parameters during swallowing. These findings provide further evidence that the primate face MI plays a critical role in the regulation of mastication and that it plays a role in the preparation for swallowing.

Animals↗
PubMed1999

Stimulation of the chewing area of the cerebral cortex induces inhibitory effects upon swallowing in sheep.

Mastication and swallowing are two tightly integrated components of food intake behavior. We investigated the effects of stimulating the chewing area of the fronto-orbital cortex (CCx) on some muscles and medullary interneurons (Ins) or motoneurons (Mns) active during swallowing. For the purpose of comparison, the lingual nerve (LN) was also stimulated during the experiments. Electromyography (EMG) and extracellular neuronal recording were used, and swallowing was reflexly induced (RIS) by stimulation of the superior laryngeal nerve (SLN). RIS was almost totally abolished during long-lasting repetitive stimulation of CCx or LN, and was strongly facilitated after stimulation cessation. Short-duration stimulation (one or a few pulses) of both the CCx and LN also inhibited triggering of deglutition when delivered just before the onset of RIS. This inhibition appeared as a delay or total suppression of the EMG and neuronal swallowing activities. It was obvious at the level of the muscles, the hypoglossal Mns and the premotoneurons (PMns; Ins of the ventral medulla near the nucleus ambiguus), as well as at the level of the Ins of the dorsal medulla (within or around the solitary tract nucleus) which are assumed to be the core of the 'central pattern generator' (CPG) for swallowing. In addition to the 'chewing-related inhibition', many ventral Ins exhibited a short latency synaptic activation after CCx and/or LN stimulation. Therefore, these Ins may play a pivotal role for reflex or cortical fast control of tongue (and jaw) muscles, and for coordinating their contractions in the context of mastication-deglutition interactions.

Animals↗
PubMed2002

Inhibitory effects of GABA(B) receptor agonists on swallowing in the dog.

The effects of the GABA(B) receptor agonists baclofen (1.4 and 7 micromol/kg i.v.) and CGP 44532 ([(2S)-3-amino-2-hydroxypropyl]methyl phosphinic acid], 0.2 and 0.7 micromol/kg i.v.) on transient lower esophageal sphincter relaxations and spontaneous and pharyngeally stimulated swallowing were investigated in conscious dogs. Both compounds inhibited transient lower esophageal sphincter relaxations dose-dependently, CGP 44532 being approximately fivefold more potent. In experiments designed to measure transient lower esophageal sphincter relaxations, spontaneous swallowing was suppressed by both compounds. When swallowing was evoked by intrapharyngeal water injection, both baclofen and CGP 44532 reduced the occurrence of primary peristalsis. It is concluded that centrally acting GABA(B) receptor agonists inhibit spontaneous and stimulated swallowing probably through an action in the central pattern generator for swallowing.

Animals↗
PubMedDate not supplied

Oropharyngeal swallowing and aging: a review.

This article provides an overview of normal oropharyngeal swallowing in relation to advanced age, with specific attention to oropharyngeal movement patterns and temporospatial swallowing durations. Swallowing disorders associated with aging are addressed with specific attention to the need for application of normative data to the diagnostic process. Attention is drawn to the need for continued research on swallowing function in the normal adult if efforts to maximize functional independence in eating and swallowing in the institutionalized adult are to be realized.

Adolescent↗
PubMed1986

Paroxysmal supraventricular tachycardia initiated by a swallowing-induced premature atrial beat.

We report a unique patient in whom electrophysiologic studies elucidated the mechanism of a rare form of swallowing-induced atrioventricular reentrant tachycardia, and for whom successful surgical ablation of an accessory pathway abolished intractable episodes of palpitation. A 64-year-old man was incapacitated by frequent attacks of palpitation following swallowing. Electrocardiograms documented paroxysmal supraventricular tachycardias initiated by a premature atrial beat or beats following swallowing. During electrophysiologic studies swallowing consistently induced premature atrial beats which in turn initiated a sustained atrioventricular reentrant tachycardia incorporating a retrogradely conducting left-sided concealed accessory pathway. The atrial activation sequence related to the premature atrial beats and the morphology of the premature P waves suggested that premature atrial beats originated in the right atrium. The mechanism of induction of premature atrial beats following swallowing remains obscure in our patient. Antiarrythmic drugs failed to prevent induction of sustained tachycardias during sequential electrophysiologic studies. The patient underwent successful surgical ablation of the accessory pathway and is free from palpitation 15 months after the surgery.

Atrial Fibrillation↗
PubMed1995

Swallowing dysfunction after cardiac operations. Associated adverse outcomes and risk factors including intraoperative transesophageal echocardiography.

The frequency, importance to patient outcomes, and independent predictors of postoperative swallowing dysfunction documented by barium cineradiography were examined in 869 patients undergoing cardiac operations over a 12-month period. Swallowing dysfunction was diagnosed in 34 patients (4% incidence) and was associated with documented pulmonary aspiration in 90% of these patients, increased frequency of pneumonia (p < 0.0001), need for tracheostomy (p = 0.0002), length of stay in the intensive care unit (p = 0.0001), and duration of hospitalization after the operation (p = 0.0001). Independent predictors of postoperative swallowing dysfunction determined by multivariate logistic regression included age (p < 0.001), length of tracheal intubation after the operation (p = 0.001), and intraoperative use of transesophageal echocardiography (p = 0.003). Dysfunctional swallowing after cardiac operations, a serious complication significantly related to postoperative respiratory morbidity and extended length of hospitalization, is more common in older patients. An association between intraoperative use of transesophageal echocardiography and swallowing dysfunction was also observed in our patients.

Aged↗
PubMed2003

Swallowing and speech function after intraoral soft tissue reconstruction with lateral upper arm free flap and radial forearm free flap.

Swallowing, speech, and morbidity were assessed postoperatively in 25 patients, 18 of whom had had intraoral defects reconstructed by lateral upper arm free flaps (LUFF) and 7 by radial forearm free flaps (RFFF). Video fluoroscopy was used to assess swallowing, the Freiburger audiometric test to assess speech; and measurement of arm circumference to assess donor site morbidity. A questionnaire was used to evaluate swallowing, speech, and donor site morbidity subjectively. The degree of impairment in swallowing depended on the site of resection. Anterior and posterior resections affected swallowing more than lateral resections. Anterior resection and the use of LUFFs reduced intelligibility. There was no significant difference in impairment between LUFF and RFFF. We conclude that the LUFFs are superior to RFFFs because they can be closed primary and the incidence of donor site morbidity is slight.

Adult↗
PubMed1998

Effect of stimulating peripheral and central neural pathways on pharyngeal muscle contraction timing during swallowing in dogs.

The effect of stimulating peripheral and central neural pathways on the electromyographic activity in the hyopharyngeal, thyropharyngeal, and cricopharyngeal muscles was studied in eight dogs during 1) eating, 2) unilateral electrical stimulation of the superior laryngeal nerve, and 3) unilateral electrical stimulation of the solitary nucleus. The duration of pharyngeal swallowing was significantly shorter during eating than during stimulation of the solitary nucleus in the anesthetized dog (mean difference 127 ms, SEM 9, n = 15). The duration of pharyngeal swallowing was significantly shorter during eating than during stimulation of the superior laryngeal nerve in the awake dog (mean difference 84 ms, SEM 13, n = 9). The duration of pharyngeal swallowing during stimulation of the superior laryngeal nerve under anesthesia was significantly shorter than during stimulation of the solitary nucleus under anesthesia (mean difference 58 ms, SEM 18, n = 9). The difference in duration of pharyngeal swallowing during stimulation of the superior laryngeal nerve between the awake state and during anesthesia was not significant (mean 19 ms, SEM 14, n = 9). It was concluded that stimulation of peripheral and central neural pathways resulted in different pharyngeal muscle contraction timing during swallowing in dogs.

Animals↗
PubMed2001

Study of movements of individual structures of the larynx during swallowing.

OBJECTIVE: The purpose of this study was to reveal movements of individual structures of the larynx during swallowing. METHODS: Subjects were 7 healthy adults, aged 24 to 32 years (average 27 years), who had no organic or functional disease of the pharynx and larynx and 2 adults with unilateral recurrent nerve palsy, aged 49 and 60 years, respectively. We used the Toshiba IIDR system, which is composed of an X-ray TV system and a digital image managing circuit. One-fifth diluted Omnipark 300 was used as contrast medium (lohexol), with 15 cc for each swallow. The mask image for subtraction was designated as the frame before laryngeal elevation during swallowing for subtraction. We obtained the images for observation and analysis after subtracting the mask image from continuously obtained images. These images were captured into a personal computer at 30 frames per s and thereafter frame-by-frame observation and analysis were performed by means of NIH image 1.56. RESULTS: We observed that the vocal folds underwent a series of movements during swallowing. (1) They adduct slowly and do not ascend; (2) then begin to ascend and continue adducting; whereby (3) they abduct for a moment while ascending. (4) Again, they adduct and achieve closure. (5) While maintaining closure, vocal folds elevate further to reach their maximal elevation; and (6) begin to abduct rapidly while maintaining maximal elevation. Finally, (7) they begin to descend and undergo repeated irregular abduction and adduction while descending. In examining the relationship between closure and opening at levels of the vocal fold and false vocal fold, we found that closure at the false vocal fold level precedes that at the vocal fold level and that opening at the vocal fold level precedes that at the level of the false vocal fold. CONCLUSION: Closure of the false vocal fold level appears important in the protection of the lower respiratory tract during swallowing.

Adult↗
PubMedDate not supplied

Management of children with swallowing disorders.

Early diagnosis and treatment of feeding and swallowing problems may improve a child's health status and quality of life and reduce health care costs. Pediatric nurse practitioners have a salient role in the early diagnosis of children at risk for feeding and swallowing problems. Increased knowledge about the normal swallowing process, children at risk for feeding and swallowing disorders, and associated symptoms enhances early diagnosis and treatment. The child's general health history and physical evaluation, along with additional diagnostic tests, provide the basis for the formulation of an individualized feeding program by an interdisciplinary team. Pediatric nurse practitioners, through their knowledge about dysphagia and participation on a interdisciplinary team, can provide support for family members and assist them in adapting to and caring for a child with a swallowing impairment.

Adaptation, Psychological↗