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PubMed1994

Effects of posture on the coordination of respiration and swallowing.

1. Although a pause in respiration during swallowing is a feature common to all mammals, inhibition usually occurs during expiration in adult humans and during inspiration in most other species. We tested the hypothesis that this difference is due, at least in part, to the position of the body while feeding. 2. The coordination of respiration and swallowing was studied in adult human subjects in two body positions; upright, which is typically human, and on hands and knees, which is similar to the feeding posture of most other animal species. 3. Our major finding was that the respiratory phase in which swallowing occurred was significantly related to posture. Swallows tended to occur late in the expiratory phase while feeding upright, but during early expiration while on all fours. 4. We speculate that the phase of respiration in which swallowing occurs changes with posture to compensate for the alterations in the mechanical properties of the upper body.

Animals↗
PubMed2001

Physiology and pathophysiology of the swallowing area of human motor cortex.

Swallowing problems can affect as many as one in three patients in the period immediately after stroke. Despite this, in the majority of cases, recovery usually occurs to a safe level after a month or two. In this review, we show how the organization of the cortical projections to swallowing muscles can account for many of the clinical observations on swallowing after stroke and explain why recovery is common in the long term. In addition, we examine approaches that may be useful in speeding up recovery of swallowing. Swallowing may be a useful model in which to study central nervous reorganization after injury.

Deglutition↗
PubMedDate not supplied

Videoendoscopic biofeedback: a simple method to improve the efficacy of swallowing rehabilitation of patients after head and neck surgery.

The value of flexible videoendoscopy as a biofeedback tool in conservative swallowing rehabilitation of patients suffering from aspiration after head and neck surgery was examined. For this purpose, the outcomes of conventional swallowing therapy and of swallowing therapy with support of videoendoscopic biofeedback were compared. In the first 40 days of swallowing therapy, videoendoscopic biofeedback significantly increased the chance of therapeutic success, shortening the period of functional rehabilitation in comparison to conventional swallowing therapy. Limitations of this visual biofeedback procedure are poor cognitive skills of the patient, rejection of the procedure by the patient and local factors that make the positioning of the endoscope difficult.

Adult↗
PubMed2005

Timing of glottic closure during swallowing: a combined electromyographic and endoscopic analysis.

OBJECTIVES: We performed a case series to enhance our understanding of the coupling between neuromuscular events and glottic closure. METHODS: We performed combined flexible video laryngoscopy and electromyography in 4 healthy human subjects. Hooked-wire electrodes were placed in the superior pharyngeal constrictor, longitudinal pharyngeal, cricopharyngeus, thyroarytenoid, genioglossus, suprahyoid, and posterior cricoarytenoid muscles. A flexible endoscope tip was positioned in the oropharyngeal-hypopharyngeal region. The subjects performed multiple trials each of 10-mL normal and super-supraglottic liquid swallows. RESULTS: Arytenoid movement consistently preceded full glottic closure and was associated with cessation of activity of the posterior cricoarytenoid muscle. In 89% of normal swallows, the glottis was partially open in the video frame before bolus passage. The maximum amount of thyroarytenoid electromyographic activity occurred during endoscopic whiteout. When subjects executed a super-supraglottic swallow, early thyroarytenoid activity coincided with arytenoid contact. CONCLUSIONS: The initial medialization of the arytenoids is due to a decrease in motor tone of the posterior cricoarytenoid muscle. Full glottic closure typically occurs late in the process of swallowing, with activation of the thyroarytenoid muscle. Shifting of arytenoid medialization and glottic closure earlier in the super-supraglottic swallow indicates that glottic closure is under significant voluntary control.

Adult↗
PubMedDate not supplied

Relearning the swallowing process.

Three patients were encountered who had physical defects that prevented them from swallowing food. They had received nourishment for a long period of time by means of tube feedings, gastrostomy in two cases and nasogastric tube in the third. Following surgical correction of the physical problems, they were still unable to swallow food. It was conceived that they had forgotten how to swallow. A program to enable them to relearn the technique of swallowing was established, similar to that used in premature infants. The three patients were successfully rehabilitated, able to eat a regular diet. The method is being evaluated in stroke patients who have lost the ability to swallow food and saliva.

Adolescent↗
PubMed1996

Subglottic air pressure: a key component of swallowing efficiency.

The relationship between tracheostomy and swallowing dysfunction has been long recognized. Often this dysfunction is manifested by aspiration, for which a number of etiologic factors may be responsible. Disruption of glottic closure has been previously demonstrated in association with the presence of an indwelling tracheostomy tube. The plugging or removal of the tracheostomy tube, or the use of an expiratory air valve, has been demonstrated to decrease aspiration and improve swallowing function. Measurement of subglottic pressure through an indwelling tracheostomy tube during swallowing demonstrated pressure peaks occurring concomitant with swallowing and laryngeal elevation. This presentation will review the evidence supporting the role of subglottic pressure rise in swallowing efficiency. Current investigational activity will be reviewed, and new areas for study will be suggested.

Algorithms↗
PubMed1998

Effects of head rotation on pharyngeal function during normal swallow.

This study quantified the effects of head rotation on pharyngeal swallowing in healthy subjects. Videofluoroscopic and oropharyngeal manometric examinations of pharyngeal swallowing were performed on seven volunteers with the head in neutral and rotated positions. Videofluoroscopic study revealed that head rotation swallow causes the bolus to lateralize away from the direction of head rotation. Pharyngeal manometric study indicated that the pharyngeal peak pressures toward the side of head rotation were significantly increased, whereas the pharyngeal pressures opposite the side of head rotation were not affected. Head rotation swallow produced a significant fall in upper esophageal sphincter (UES) resting pressure and a delay in UES closing. We concluded that the head rotation swallow in normal subjects not only alters the bolus pathway, but also has a useful effect on both pharyngeal clearance and UES dynamics.

Adult↗
PubMed1999

Swallowing disorders in paralysis of the lower cranial nerves: a functional analysis.

Deficits of the lower cranial nerves (nerves IX, X, XI, and XII) occurring after treatment of skull base tumors may cause disabling swallowing disorders. To assess the mechanisms of swallowing disorders involved in such cases, we performed functional examinations: a videoendoscopic swallowing study and simultaneous manometry and videofluoroscopy in 7 patients. This study shows that the main mechanism of the swallowing disorders was a disturbance of the pharyngeal stage, including a decrease of pharyngeal propulsion, reduced laryngeal closure, and cricopharyngeal dysfunction, which led to aspiration. Decreased pharyngeal propulsion was found in 6 patients, with a very high correlation between fiberoscopy and simultaneous manometry-fluoroscopy. The responsibility of the upper esophageal sphincter in swallowing disorders was more difficult to assess. The role of the upper esophageal sphincter and pharyngeal propulsion in the onset of the problem is discussed in regard to the cricopharyngeal myotomy.

Adult↗
PubMedDate not supplied

Teaching children with attention deficit hyperactivity disorder (ADHD) and autistic disorder (AD) how to swallow pills.

One barrier to medication adherence in pediatric populations is difficulty swallowing pills. Some children may not have prerequisite skills for pill swallowing, while others may have developed conditioned anxiety from repeated negative experiences. Eight children with attention deficit hyperactivity disorder or autistic disorder participated in behavioral training to increase cooperation with pill swallowing. A pill-swallowing protocol was utilized during practice sessions with placebo "pills" of increasing size to implement systematic desensitization. Seven of the 8 children swallowed medication with a therapist. Six of the 8 children maintained treatment gains over time. Interventions used to succeed with these children are presented along with methods to reduce conditioned behavioral distress.

Administration, Oral↗
PubMed2006

Pill swallowing ability and training in children 6 to 11 years of age.

Despite the widespread view that children have difficulty swallowing pills, data are limited. In an observational cohort study, pill swallowing ability (small oral tablet) was assessed in children age 6 to 11 years. A total of 113 of 124 subjects (91%) swallowed a tablet using an ordinary cup or a patented pill cup. All 57 subjects who initially said they could swallow a pill were capable. Forty-seven learned with an ordinary cup and nine with the pill cup. Eleven did not learn. The majority of children (91%) age 6 to 11 years were able to successfully swallow a small oral tablet.

Child↗
PubMed1999

Suppression of jaw-opening and trigemino-hypoglossal reflexes during swallowing in the cat.

Jaw-opening and trigemino-hypoglossal reflexes can be evoked by innocuous as well as noxious afferents from intra-oral structures. It has been reported that the amplitude of the jaw-opening reflex evoked by weak electrical stimulation of the upper lip is subject not only to tonic suppression but also to phase-linked modulation during mastication. In this study, we investigated whether the jaw-opening and trigemino-hypoglossal reflexes are modulated during swallowing. Data were obtained from 8 chloralose-anesthetized cats. Reflexes were monitored by electromyographic activities recorded from the anterior digastric, genioglossus, and styloglossus muscles and, after paralysis, by the efferent discharge in the digastric and hypoglossal nerves. Swallowing was elicited either by water dropped on the tongue or by repetitive stimulation of the superior laryngeal nerve. Jaw-opening and trigemino-hypoglossal reflexes were evoked by stimulation of the lingual nerve, and the evoked afferent volley was recorded from the Gasserian ganglion so that the threshold of the lingual nerve could be determined. The following results were obtained: (1) The jaw-opening and trigemino-hypoglossal reflexes evoked by stimulation of the low-threshold, but not high-threshold, lingual afferents were remarkably suppressed during swallowing; and (2) both the jaw-opening and trigemino-hypoglossal reflexes evoked by low-threshold lingual afferents were suppressed during fictive swallowing after the animals were paralyzed. We conclude that the jaw-opening and trigemino-hypoglossal reflexes evoked by low-threshold lingual afferents are suppressed during swallowing by a central motor program.

Afferent Pathways↗
PubMed1998

Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients.

The effect of radiation on speech and swallowing function was assessed for 18 patients surgically treated for oral and oropharyngeal cancer. Nine patients received surgical intervention and postoperative radiation therapy, and nine received surgery only. Patients were matched regarding percentage of oral tongue resected, percentage of tongue base resected, locus of resection, and method of reconstruction. Speech and swallowing function was assessed before and at 1, 3, 6, and 12 months after surgery following a standardized protocol. Speech tasks included an audio recording of a brief conversation and of a standard articulation test; swallowing function was examined with videofluoroscopy. Statistical testing indicated that overall speech function did not differ between the irradiated and nonirradiated patients. Irradiated patients had significantly reduced oral and pharyngeal swallowing performance, specifically, longer oral transit times on paste boluses, lower oropharyngeal swallow efficiency, increased pharyngeal residue, and reduced cricopharyngeal opening duration. Impaired function may be the result of radiation effects such as edema, fibrosis, and reduced salivary flow. Increased use of tongue range-of-motion exercises during and after radiation treatment may reduce the formation of fibrotic tissue in the oral cavity and may improve pharyngeal clearance by maintaining adequate tongue base-to-pharyngeal wall contact.

Adult↗
PubMedDate not supplied

Radiologic evaluation of the oral stage of swallowing.

The oral stage of swallowing was radiologically evaluated in 19 patients with swallowing complaints. Eight patients had had surgical resection and reconstruction due to tumours of the tongue, floor of the mouth or mandible. Eleven patients had suffered from cerebrovascular disease. All patients had incoordination of tongue movements including defective initiation of pharyngeal swallow. In patients who had undergone surgical resection, oral dysfunction correlated with the extension of resection as well as type of reconstruction, and was more profound compared with the disorder present in patients with cerebrovascular disease. Moreover, muscular derangement due to surgery of the floor of the mouth interfered with the elevation of the hyoid bone, larynx and pharynx and thereby the pharyngeal stage of swallowing also became abnormal. Cineradiography seems to be an appropriate method for evaluation of the oral stage of swallowing in patients with deglutition complaints.

Aged↗
PubMedDate not supplied

Posture of the head and pharyngeal swallowing.

Closure of the laryngeal vestibule during swallowing is important for protection of the airways. The present investigation included 53 patients with dysphagia examined cineradiographically with the head held in resting posture, flexion and extension. The ability to protect the airways by the downward movement of the epiglottis and by obliteration of the laryngeal vestibule was studied in different postures of the head. Of 35 patients with normal laryngeal obliteration with the head in resting position 10 showed a defective closure at swallowing in extension. In 18 patients with defective closure of the laryngeal vestibule in resting position 9 were improved on flexion and two on extension of the head. In one patient with defective closure of the laryngeal vestibule in resting position swallowing in flexion showed an aggravated dysfunction. In four other patients the defective closure became more marked on extension. Four patients had less effective downward movement of the epiglottis with the head in extension. Of 10 patients with defective epiglottic movement with the head in resting position two were improved on tilting the head forwards. The results show that the position of the head influences the closure of the airways during swallowing. Patients with defective protection of the laryngeal vestibule should be instructed to swallow with the head tilted forwards.

Adolescent↗
PubMed2001

Neural control of tongue movement with respect to respiration and swallowing.

The tongue must move with remarkable speed and precision between multiple orofacial motor behaviors that are executed virtually simultaneously. Our present understanding of these highly integrated relationships has been limited by their complexity. Recent research indicates that the tongue s contribution to complex orofacial movements is much greater than previously thought. The purpose of this paper is to review the neural control of tongue movement and relate it to complex orofacial behaviors. Particular attention will be given to the interaction of tongue movement with respiration and swallowing, because the morbidity and mortality associated with these relationships make this a primary focus of many current investigations. This review will begin with a discussion of peripheral tongue muscle and nerve physiology that will include new data on tongue contractile properties. Other relevant peripheral oral cavity and oropharyngeal neurophysiology will also be discussed. Much of the review will focus on brainstem control of tongue movement and modulation by neurons that control swallowing and respiration, because it is in the brainstem that orofacial motor behaviors sort themselves out from their common peripheral structures. There is abundant evidence indicating that the neural control of protrusive tongue movement by motoneurons in the ventral hypoglossal nucleus is modulated by respiratory neurons that control inspiratory drive. Yet, little is known of hypoglossal motoneuron modulation by neurons controlling swallowing or other complex movements. There is evidence, however, suggesting that functional segregation of respiration and swallowing within the brainstem is reflected in somatotopy within the hypoglossal nucleus. Also, subtle changes in the neural control of tongue movement may signal the transition between respiration and swallowing. The final section of this review will focus on the cortical integration of tongue movement with complex orofacial movements. This section will conclude with a discussion of the functional and clinical significance of cortical control with respect to recent advances in our understanding of the peripheral and brainstem physiology of tongue movement.

Animals↗
PubMed1978

Respiratory suppression and swallowing from introduction of fluids into the laryngeal region of the lamb.

Introduction of 0.9% NaCl or undiluted fetal tracheal fluid into the laryngeal region produced no suppression of breathing in lambs during the perinatal period. As NaCl or tracheal fluid solutions were increasingly diluted with water, progressively greater respiratory suppression associated with rapid swallowing was observed. Introduction of amniotic fluid was associated with variable suppression of respiration. The swallowing induced by the dilute solutions was as rapid as two swallows per sec. Lambs 3 months of age swallowed when water was introduced into the laryngeal region, but were able to alternate swallows between breaths without suppression of breathing.

Amniotic Fluid↗
PubMed2002

A kinematic model of swallowing in Aplysia californica based on radula/odontophore kinematics and in vivo magnetic resonance images.

A kinematic model of the buccal mass of Aplysia californica during swallowing has been developed that incorporates the kinematics of the odontophore, the muscular structure that underlies the pincer-like grasping structure, the radula. The model is based on real-time magnetic resonance images (MRIs) of the mid-sagittal cross section of the buccal mass during swallowing. Using kinematic relationships derived from isolated odontophores induced to perform feeding-like movements, the model generates predictions about movement of the buccal mass in the medio-lateral dimension during the feeding cycle that are well-matched to corresponding coronal MRIs of the buccal mass during swallowing. The model successfully reproduces changes in the lengths of the intrinsic (I) buccal muscles I2 and I3 measured experimentally. The model predicts changes in the length of the radular opener muscle I7 throughout the swallowing cycle, generates hypotheses about the muscular basis of radular opening prior to the onset of forward rotation during swallowing and suggests possible context-dependent functions for the I7 muscle, the radular stalk and the I5 (ARC) muscle during radular opening and closing.

Animals↗
PubMed2005

Comparison of effects of dry versus wet swallowing on Eustachian tube function via a nine-step inflation/deflation test.

The aim of the present study is to evaluate the effect of swallowing type (dry versus wet) on the outcome of a nine-step inflation/deflation tympanometric Eustachian tube function (ETF) test in healthy adults. Fourteen normal healthy volunteers, between 19 and 28 years of age, were included in the study. The nine-step test was performed in two different test procedures: (1) test with dry swallows (dry test procedure) and (2) test with liquid swallows (wet test procedure). If the equilibration of middle-ear (ME) pressure was successful in all the steps of the nine-step test, ETF was considered 'Good'. Otherwise, the test was considered 'Poor', and the test was repeated at a second session. In the dry test procedure, ETF was 'Good' in 21 ears at the first session and in 24 ears after the second session (p > 0.05). However, in the wet test procedure, ETF was 'Good' in 13 ears at the first session and in 21 ears after the second session (p < 0.05). At the first session, ETF was 'Good' in 21 and 13 ears in the dry and wet test procedures, respectively. The difference was statistically significant (p < 0.05). However, after the second session, the overall number of ears with 'Good' tubal function was almost the same in both test procedures (24 ears at dry test procedures versus 21 ears at wet test procedures;p > 0.05). Dry swallowing seems to be more effective for the equilibration of ME pressure. Thus, a single-session dependent evaluation of ETF may be efficient for the dry test procedure of the nine-step test. Swallowing with water may be easier for subjects, but a repetition of the test at a second session may be necessary when the test result is 'Poor'.

Adult↗