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PubMed1995

Pharyngeal and swallowing disorders in infants.

Although true vomiting is an unusual manifestation of pharyngeal or swallowing disorders in infants and children, the forceful regurgitation of feedings seen with respiratory distress in these children may be interpreted by the clinician as vomiting episodes. This scenerio usually is caused by structural abnormalities of the upper airway or swallowing discoordination placing food as an obstruction in the airway during feedings. A good clinical history and physical examination of affected children often will disclose an anatomic cause for regurgitated feedings, but swallowing disorders are more subtle and usually require a complete swallowing evaluation. The essential components in treating these problems in children include the removal of the airway obstruction or rehabilitation of feeding and swallowing. The approach to treatment is often multidisciplinary in nature and highly individualized.

Airway Obstruction↗
PubMed1994

Swallowing in motor neurone disease.

Ninety-two patients with motor neurone disease have been assessed clinically and radiologically for evidence of swallowing problems. At the time of examination, moderate or severe swallowing difficulty was present in 89% of those whose disease had presented as bulbar palsy, in 45% of those in whom the disease began many months before as progressive muscular atrophy and in 29% of those with amyotrophic lateral sclerosis. Patients with more severe swallowing symptoms appeared more likely to have abnormal findings on videofluoroscopy overall. However, not all patients with an abnormal radiological picture had swallowing difficulties. It is suggested that radiological signs should only be used within the context of clinical symptoms and signs in the selection of patients for palliative surgery. Thirteen patients with pseudobulbar symptoms and signs had a cricopharyngeal myotomy performed: two suffered major post-operative complications. However, the satisfaction rate was 89% and we recommend cricopharyngeal myotomy for such patients. Pharyngostomy was performed for seven patients unable to initiate swallowing, six had post-operative complications.

Age of Onset↗
PubMed1993

The effect of fetal acoustic stimulation on fetal swallowing and amniotic fluid index.

OBJECTIVE: To determine the effect of fetal acoustic stimulation on fetal swallowing and amniotic fluid (AF) index in an attempt to understand the potential mechanism for fetal compromise following fetal acoustic stimulation. METHODS: Fetal swallowing movements and AF index were assessed in 90 full-term fetuses before and after fetal acoustic stimulation. Fetal swallowing movements were identified on a video monitor and measured in terms of the percentage of time they occurred during 30 minutes of observation. The fetal heart rate was recorded 30 minutes before and 30 minutes after fetal acoustic stimulation. RESULTS: The mean (+/- standard deviation) percentage of time spent by the fetus in swallowing increased from 16.1 +/- 6% before to 44.3 +/- 10.3% after stimulation (P < .005). The AF index decreased from 14.6 +/- 8.4 cm before acoustic stimulation to 12.8 +/- 6.8 cm afterward (not statistically significant). Seven of 17 patients (41%) with borderline AF indexes developed oligohydramnios after the fetal acoustic stimulation; two of these demonstrated persistent variable decelerations that required obstetric intervention. CONCLUSIONS: Fetal acoustic stimulation is associated with increased fetal swallowing activity, which can lead to diminution of AF volume. The AF index should be assessed in fetuses before acoustic stimulation and if the volume is low, acoustic stimulation should be used with extreme caution.

Acoustic Stimulation↗
PubMed1995

[Swallowing pattern in skeletal Class III malocclusion].

In this research, we compared the swallowing pattern in 33 normal occlusion adults with that in 29 skeletal Class III malocclusion adults, using computerized videofluoscopy. We found that: 1) in skeletal Class III malocclusion patients, the tongue, the hyoid bone and the mandible were in much lower position than those in normal people at postural position. The gap separation between the upper and lower lip was much larger. So was the space between the upper and lower molars. During swallowing, the tongue tip moved upward and backward, and continually moved back along with the backward movement of the tongue dorsum. This was the typical tongue retraction swallowing pattern in Class III malocclusion. The lips kept separation during deglutition, so did the molar region. 2) Abnormal swallowing pattern in skeletal Angle Class III patients was the adaptable change with the dentoalveolar disharmony, while the long time abnormal swallowing could change dentoalveolar structure.

Adolescent↗
PubMed1995

Effects of oral myofunctional therapy on swallowing and sibilant production.

This study investigated the effectiveness of oral myofunctional therapy in eliminating a 16 year-old girl's tongue thrust swallowing pattern and mild sibilant distortion. An ABC design was used where Phase A had eight baseline sessions (no treatment), Phase B had 14 oral myofunctional therapy sessions, and Phase C had four articulation treatment sessions. Dependent measures of swallowing and sibilant production were obtained in each session. A third dependent variable, labial diadochokinetic rate, was also measured each session and served as a control for maturation. Oral myofunctional therapy was shown to be effective in eliminating the tongue thrust swallowing pattern of this subject, but not her sibilant distortion. However, her sibilant distortion reduced after one articulation treatment session and was maintained at negligible levels over the next three treatment sessions. As expected, labial diadochokinetic rate remained stable across the three phases. At the conclusion of Phase C, two bi-weekly home visits revealed that the subject had maintained and generalized her new swallowing pattern. Measures obtained six months after completion of Phase C indicated that the subject had maintained her new swallowing and speech production behaviors. The subject's maximal tongue strength and endurance were below expected normal values at the initiation of the study and increased during the study. Her tongue endurance appeared more sensitive to the effects of oral myofunctional training than tongue strength and, unlike tongue strength, tongue endurance decreased in the six month period following completion of the study.

Adolescent↗
PubMed1998

Functional swallowing therapy after treatment for head and neck cancer can outcome be predicted?

Possible prognostic factors for swallowing after curative treatment of head and neck cancer were investigated by retrospectively analyzing the records of 82 consecutively treated patients. All of them had an exhaustive assessment of swallowing after the oncological treatment, and all had an adequate follow-up. In general, a major improvement in swallowing quality was obser-ved after rehabilitation, although some patients (9/82) still had major problems. Patients with transport problems have a significantly better prognosis than patients with aspiration. No single parameter was strongly correlated with the outcome of swallowing. A weighted score (presence/absence of pharyngeal reflexes combined with the quality of laryngeal sphincter function) was of satisfactory prognostic value for improvement in the quality of swallowing.

Adult↗
PubMed2004

Bioenergetics-based modeling of individual PCB congeners in nestling tree swallows from two contaminated sites on the upper Hudson River, New York.

A bioenergetics-based model was used to simulate the accumulation of total PCBs and 20 PCB congeners by nestling tree swallows at two contaminated sites on the Upper Hudson River, New York. PCB concentrations in birds were calculated as the sum of inherited residues and those acquired through consumption of contaminated insects. Close agreement between simulations and measured residues in 5-, 10-, and 15-day-old nestlings was obtained when PCB concentrations in the diet were set equal to those in food boli taken from adult birds. These simulations were further optimized by fitting the value of a dietary assimilation efficiency constant. Fitted constants for both sites were similar and averaged about 0.7. An evaluation of model performance for individual congeners provided no evidence of metabolic biotransformation. The results of this study are consistent with a companion effort in which principal components analysis was used to compare PCB congener patterns in insects and in tree swallow eggs, nestlings, and adults. Together, these studies establish a quantitative linkage between nestling tree swallows and the insects that they consume and provide strong support for the use of nestling swallows as a biomonitoring species for exposure assessment.

Animals↗
PubMed2006

Barn swallows before barns: population histories and intercontinental colonization.

The barn swallow (Hirundo rustica) is one of most widely distributed swallows, owing in part to its recent switch from natural nest sites to human structures. We conducted phylogenetic analysis of mitochondrial (mt) and nuclear DNA to explore the recent evolutionary history of this species. Strongly supported mtDNA clades corresponded to Europe, Asia and North America plus the Baikal region of Asia. Analysis of sequence data from a sex-linked nuclear gene was unable to recover the phylogenetic splits in the mtDNA tree, confirming that the main clades evolved recently. The phylogenetic pattern suggests that the ancestral area of the barn swallow was the holarctic; most divergence events are consistent with vicariance. Most unexpectedly, analyses show that barn swallows from North America colonized the Baikal region in the recent past (one fixed substitution). This dispersal direction is opposite of that for most nearctic-palearctic taxon exchanges. Although this invasion was envisioned to coincide with the appearance of new types of human dwelling in the Baikal region, calibration of molecular divergence suggests an older dispersal event. A recent history of gene flow within the main palearctic clades is consistent with range and population expansion owing to new nesting opportunities provided by human settlements. Contrary to expectation, populations in North America appear historically larger and more stable than those in the palearctic. The Baikal population apparently has not increased greatly since colonization.

Animals↗
PubMed2006

Bioaccumulation and trophic transfer of polychlorinated biphenyls by aquatic and terrestrial insects to tree swallows (Tachycineta bicolor).

Insectivorous passerines often bioaccumulate polychlorinated biphenyls (PCBs) via trophic transfer processes. Tree swallows (Tachycineta bicolor) frequently are used for estimating PCB bioaccumulation, yet the focus on specific trophic links between contaminated sediment and bird has been limited. Bioaccumulation of PCBs from sediment to tree swallows was examined with focus on trophic pathways by simultaneously examining PCBs in emergent aquatic and terrestrial insects and gut contents of nestlings. Total PCB concentrations increased from sediment (123.65 +/- 15.93 microg/kg) to tree swallow nestlings (2,827.76 +/- 505.67 microg/kg), with emergent aquatic insects, terrestrial insects, and gut content samples having intermediate concentrations. Biota-sediment accumulation factors (BSAFs) varied among congeners for tree swallow nestlings and for male and female Chironomus spp. For nestlings, the highest BSAF was for the mono-ortho-substituted congener 118. Nestling biomagnification values were similar for gut contents and female Chironomus spp., suggesting this diet item may be the main contributor to the overall PCB transfer to nestlings. However, gut content samples were highly variable and, on a PCB congener pattern basis, may have been influenced by other taxa, such as terrestrial insects. Considering dietary plasticity of many insectivorous birds, the present study suggests that a variety of potential food items should be considered when examining PCB accumulation in insectivorous passerines.

Animals↗
PubMed2005

Behavioural and energetic responses to body state in male and female barn swallows (Hirundo rustica).

Females and males often have different roles when attending young. The factors responsible for shifts in the balance of effort when both sexes provision their young are not clear. This study asked if sex-specific behaviour and provisioning rules in barn swallows (Hirundo rustica) were dependent on individual body-state or affected by the state of their provisioning partner. To assess this male and female barn swallows underwent overnight warming manipulations whilst provisioning 10-14 day old nestlings, a time when energetic demands are maximal. The overnight warming treatment reduced thermoregulatory costs and provided birds with extra energy reserves at dawn. Only one member of a pair was manipulated in this way, whilst their partners were left un-manipulated to assess their response to their partner's elevated body-state. The energetic and behavioural responses to these manipulations were followed over the subsequent 24-h. I found that warmed male and female barn swallows increased their energy expenditure and nest visitation rates to the same extent after manipulation, implying a trade-off in resource allocation, which was biased towards reproductive effort. There was no effect of gender. Males paired with manipulated females showed no energetic or behavioural adjustments, however, females paired with manipulated males tended to increase both energy expenditure and nest visitation. This study provides evidence that energy reserves constrain behaviour, and that male and female swallows normally follow the same state-dependent rules when provisioning young.

Analysis of Variance↗
PubMed1992

Validation of the 3-oz water swallow test for aspiration following stroke.

A 3-oz water swallow test identified 80% (16/20) of patients aspirating during a subsequent videofluoroscopic modified barium swallow examination (sensitivity, 76%; specificity, 59%). It also identified patients with more severe dysphagia aspirating larger amounts (sensitivity, 94%; specificity, 26%) or thicker consistencies (sensitivity, 94%; specificity, 30%) of test material. The 3-oz water swallow test is a sensitive screening tool for identifying patients at risk for clinically significant aspiration who need referral for more definitive modified barium swallow evaluation.

Aged↗
PubMed1988

Timing of major events of pharyngeal swallowing.

Normal swallowing depends on the synergistic motion of the tongue, larynx, and pharyngeal wall to develop a bolus pressure gradient for bolus transit. However, few studies have provided timing relationships for clinical evaluations. To examine the timing relationships of pharyngeal anatomic motion, pressure generation, and bolus transit in the normal swallow, this study uses a new method, manofluorography, to correlate these swallowing aspects. Thirty-one events were timed by analyzing five swallows each in 14 normal subjects. A different perspective of pharyngeal physiology is presented.

Deglutition↗
PubMed2001

Bulimia and swallowing: cause for concern.

OBJECTIVE: To determine whether there is evidence of a relationship between bulimia and abnormalities in swallowing function. METHOD: Literature review across a variety of professional areas concerning the physiological effects of bulimia on oropharyngeal swallow structures and function. RESULTS: Investigations of bulimic subjects have identified abnormalities in the oral cavity and oropharynx including dental erosion, changes in taste, tissue manifestations, and potential motility disorders that could impact swallowing function. DISCUSSION: While there is cause for concern regarding the effects of repeated self-induced vomiting behavior in bulimic subjects on swallowing function, more research is needed.

Bulimia↗
PubMed2002

Swallowing and speech ability after treatment for head and neck cancer with targeted intraarterial versus intravenous chemoradiation.

OBJECTIVE: RADPLAT (concurrent selective supradose intraarterial cisplatin and external-beam irradiation) delivers extraordinarily high cisplatin concentration to head and neck structures. This study was designed to quantify and compare RADPLAT and systemic chemoradiation treatment effects on swallowing and speech. METHODS: Videofluorographic swallowing studies and articulation testing of 14 head and neck cancer patients treated with RADPLAT were compared with 16 treated with systemic chemoradiation 1 month after treatment. RESULTS: RADPLAT and systemic chemoradiation patients did not differ significantly on most swallow outcome measures, and there was significantly less aspiration on 1 and 3 mL liquid for RADPLAT individuals. Speech function was comparable except for RADPLAT's significantly worse /s, z/ productions. CONCLUSIONS: Increased concentration of cisplatin to the head and neck did not result in generally reduced swallowing or articulatory function.

Adult↗
PubMed2001

Management of swallowing in supraglottic and extended supraglottic laryngectomy patients.

BACKGROUND: Aspiration of food and liquid following supraglottic and supracricoid laryngectomy has been documented and found to be the most frequent major postoperative complication that extends hospitalization. The advantages as well as disadvantages of discharging a patient with percutaneous endoscopic gastrostomy (PEG) placement and home therapy versus an aggressive in-hospital dysphagia management program remain controversial. The present investigation examines an aggressive in-patient postoperative dysphagia management program following decannulation. METHODS: Twenty-one patients participated in a four-part dysphagia management program following decannulation: patient education, indirect therapy, swallowing evaluation, and nutrition education. RESULTS: Eleven patients achieved functional swallowing goals prior to discharge with no reports of pneumonia or rehospitalization over a 3-month follow-up period. Six patients were discharged with a tracheostomy and duo tube; five of these patients were started on an oral diet the same day of decannulation. Four patients decannulated prior to discharge did not achieve functional swallowing. CONCLUSION: Certain patients can achieve functional swallowing goals prior to discharge and avoid the cost and surgical placement of a PEG. This group required an additional 2 to 3 days of hospitalization; however, the usual and customary charges for aggressive dysphagia management in this group were exceeded by charges for PEG placement and in-home therapy according to pricing guidelines for the hospital where these patients were treated. Specific patient profiles of those who were unsuccessful relate to extent of surgery, ie, supraglottic + base of tongue (SUPRA + BOT) and supraglottic + vocal fold (SUPRA + VF) resection, and non-compliance. Complicated patients often require longer rehabilitation and may benefit from a PEG at the time of surgery.

Aged↗
PubMed1999

Recording of swallowing events using electromyography as a non-invasive measurement of salivation.

The present study examined whether the measurement of swallowing activity by electromyography (EMG) provides a sensitive and valid method for the assessment of the amount of saliva secreted. Thirteen subjects tasted lemon juice and water, and smelled lasagna and hay, while the amount of saliva, measured with the aid of cotton dental rolls, was compared with the number of peaks in the EMG activity of the musculus digastricus. Swallowing indeed differentiated between the stimuli and the correlation between the number of swallows and the amount of saliva was significant. The present data suggest that monitoring the swallowing movement using EMG might be a sensitive, valid and reliable method for the measurement of salivary flow. The use is recommended for the measurement of salivation when a simple and non-invasive method is needed.

Adult↗
PubMed2005

The localization of central pattern generators for swallowing in humans--a clinical-anatomical study on patients with unilateral paresis of the vagal nerve, Avellis' syndrome, Wallenberg's syndrome, posterior fossa tumours and cerebellar hemorrhage.

BACKGROUND: Our understanding of brainstem swallowing centers is mainly based on experimental animals. In order to solve this problem also in humans, a clinical-anatomical study on dysphagic patients with different lesion patterns was performed. PATIENTS AND METHODS: We studied 43 consecutively admitted dysphagic patients with unilateral paresis of the vagal nerve (PVN), Avellis' syndrome (AS), Wallenberg's syndrome (WS), posterior fossa tumour (PFT) or cerebellar hemorrhage (CH) with regard to clinical and anatomical aspects. FINDINGS: There was a continuum with regard to functional outcome from neurogenic dysphagia (ND): Patients with PFT or CH had a significantly worse outcome than patients with WS; the outcome of WS patients was significantly worse than that of patients with PVN or AS. In AS only the Nucleus ambiguus (NA) and its surrounding reticular formation (RF) were affected. In all patients with WS, the infarctions of the dorsolateral medulla were situated in the rostral third of the medulla and affected the NA and the Nucleus tractus solitarii (NTS) with their surrounding RF. In patients with PFT and CH, the NTS and its surrounding RF were affected on both sides. The overlap area of WS and PFT lesions is situated in the NTS and the surrounding RF, especially in its Nucleus parvocellularis. INTERPRETATION: Our results point to the fact, that in humans the dorsomedial central pattern generators (CPGs) for swallowing are situated in the rostral part of the dorsal medulla oblongata near the NTS/surrounding RF (especially Nucleus parvocellularis) and that the dorsomedial CPGs are superior to the ventrolateral CPGs (near the NA/surrounding RF) with regard to their swallowing-relevance. Furthermore, we hypothesize that due to the individual asymmetry of the swallowing-dominant forebrain hemisphere - the outcome from ND in WS depends on the side of the medullary infarction.

Adult↗
PubMed1990

Axonal branching of medullary swallowing neurons projecting on the trigeminal and hypoglossal motor nuclei: demonstration by electrophysiological and fluorescent double labeling techniques.

The projections of ventral medullary reticular neurons on both trigeminal (Vth) and hypoglossal (XIIth) motor nucleus were studied in sheep anesthetized with halothane. In a first series of experiments, extracellular microelectrodes were used to record the activity of medullary swallowing interneurons (SINs) located in the ventral region (around the nucleus ambiguus) of the swallowing center. Antidromic activation after electrical stimulation of the Vth and XIIth nuclei was tested in 83 SINs. For 38 SINs a clear antidromic activation was observed and for 8 of them the response was triggered by stimulation of either nucleus. As confirmed by the reciprocal collision test, these 8 SINs had branched axons sending information to both nuclei tested. Average latencies for antidromic activation of branched SINs after stimulation of the XIIth and the Vth motor nucleus were 2.2 +/- 0.6 ms and 2.7 +/- 0.8 ms respectively. The axonal conduction velocity of these neurons was 4.4 +/- 1.3 m/s for the collateral to the Vth motor nucleus and 2.7 +/- 0.7 m/s for axons projecting to the XIith motor nucleus. In a second series of experiments the double retrograde labeling technique was used to confirm the existence of neurons with branched axons in the medullary regions corresponding to the swallowing center. Small and well localized injections of Fast Blue (FB) and Diamidino Yellow (DY) fluorescent tracers were made in the Vth and in the XIIth motor nucleus respectively. A relatively large number of double-labeled cells was found in the ventral region of swallowing center (reticular formation around the nucleus ambiguus, 2-4 mm in front of obex).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗