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PubMed1987

Adaptive mechanisms of speech and swallowing after combined jaw and tongue reconstruction in long-term survivors.

Twelve patients have been studied for speech and swallowing function after major combined jaw and tongue reconstruction with the microvascular iliac bone and groin skin composite flap. Cinegraphic barium swallows demonstrated that for bolus propulsion, it is important to be able to occlude the palate with the flap. Glottic competence prevents aspiration. Speech studies show that although there is loss of certain speech sounds, approximate sounds are substituted. Speech is intelligible when soft-tissue contact to the palate can be accomplished. The adaptive mechanisms in these patients have been compared with the mechanisms used by a patient with uncorrected congenital aglossia and hypomandibulosis who developed excellent speech and swallowing. The mobility of this patient's mouth and pharynx was similar to that in the reconstructed cancer patients who were able to swallow and speak. This procedure has become our reconstruction method of choice for these major defects.

Adult↗
PubMed1995

Swallow thresholds in human mastication.

Brazil-nut particles were broken down and classified by sieves into four classes of particle size. Samples of these classes were suspended in plain yoghurt in varying concentrations and presented to nine humans for chewing. Both the number of chews made before swallowing and the time needed to swallow increased significantly with particle size and concentration but the chewing frequency (number of chews/time) decreased. The rate of change of the chewing frequency, averaged over the chewing sequence (chewing frequency/time), was calculated for each food input and termed the swallowing index. This index did not differ significantly for concentrations above 20%, but increased sharply at lower concentrations. These results were interpreted in terms of a model in which food is swallowed only when particles are both small enough and sufficiently lubricated. For our food mixture, the lubrication threshold was satisfied by a 20% concentration and the particle-size threshold was 1.4 mm. Chews made with concentrations lower than this and containing smaller particle sizes were few in number and slow, reflecting the need to detect particle size with the oral mucosa.

Adult↗
PubMed1994

Swallowing problems in neuromuscular disorders.

Feeding problems in patients with neuromuscular diseases are frequently underestimated and poorly analyzed. To gain a better understanding of the most common complaints, we surveyed 451 patients and received 409 responses representing seven disorders. Difficulties in the pre-oral phase of swallowing were encountered primarily in Duchenne muscular dystrophy (DMD), limb-girdle muscular dystrophy (LGMD), facio-scapulo-humoral muscular dystrophy (FSHMD), and spinal muscular atrophy (SMA). A limitation in the ability to open the mouth was also noted in SMA. Some features are characteristic of certain diseases such as macroglossia in DMD and dryness of the mouth in dermatomyositis and polymyositis (DMPM) and myasthenia gravis (MG). Posterior swallowing time is especially affected in MG, dermatomyositis and polymyositis, LGMD, and SMA. Overall prevalence of feeding disability in five disorders (SMA, myotonic dystrophy [MD], DMPM, FSHMD, MG) was 34.9%. A better understanding of the swallowing problems associated with these disorders may help in choosing treatment possibilities, technical aids, adaptation of the consistency of foods, swallowing rehabilitation, and nutritional support by the non-oral route.

Adolescent↗
PubMed1988

Projections from the medullary swallowing center to the hypoglossal motor nucleus: a neuroanatomical and electrophysiological study in sheep.

Neurons of the hypoglossal (XIIth) motor nucleus participate in swallowing, but nothing is known of the input to these cells from swallowing interneurons (SIN) belonging to the medullary swallowing center (SC). After electrophoretic injection of horseradish peroxidase within the XIIth motor nucleus in sheep, labeled neurons were found principally in the ipsilateral ventrolateral reticular formation, 1-4 mm rostral to the obex which corresponds to the ventral region of the SC. Labeled cells were observed in the region of the nucleus of the tractus solitarius (dorsal region of the SC), predominantly when the injection site of HRP extended beyond the XIIth nucleus. The projections of ventral SIN to the XIIth nucleus was confirmed electrophysiologically. Twenty-seven of 98 tested SIN were antidromically activated (latency: 2.7 +/- 1.5 ms) by stimulating the XIIth nucleus. Twenty-one of these were histologically localized in the ventral SC, and only one in the dorsal SC. The other 5 SIN were located in the ventral group according to their stereotaxic coordinates. Our data show that SIN in the ventral reticular formation, part of the medullary SC, project to the XIIth motor nucleus; we suggest that ventral SIN are command interneurons for the different pools of motoneurons involved in swallowing.

Action Potentials↗
PubMed1992

Oropharyngeal swallowing in normal adults of different ages.

In an effort to evaluate the effect of normal aging on oropharyngeal events of swallowing, 80 normal volunteers, stratified by gender into four age groups, were studied. Liquid and semisolid swallows were performed and recorded simultaneously using videofluoroscopy and manometry. Several parameters, including total duration of oropharyngeal swallowing, were significantly longer in the oldest age group than in any other age group. A delay in initiation of maximal hyolaryngeal excursion primarily accounted for the longer durations with increased age. Significant durational changes also were found as a function of bolus consistency and presence or absence of the manometry tube. Females had a longer duration of upper esophageal sphincter (UES) opening. The amplitude of pharyngeal pressures, duration of peak pharyngeal pressures, and rate of propagation of the contractions were not significantly different for age, gender, or consistency of bolus. No significant differences were found between age groups or between genders in UES pressure. Normal aging affects some parameters of swallowing, while others are preserved.

Adult↗
PubMed1992

Pharyngeal clearance during swallowing: a combined manometric and videofluoroscopic study.

The deglutitive pharyngeal contraction was analyzed using simultaneous videofluoroscopic and manometric studies of eight volunteers. Anterior, posterior, and longitudinal movements of the pharyngeal surfaces, relative to the cervical vertebrae, were measured during swallows of 5 and 10 mL of liquid barium. Profound pharyngeal shortening during bolus transit through the pharynx eliminated access to the larynx and elevated the upper esophageal sphincter to within 1.5 cm of the retrolingual pharynx. Bolus head movement through the pharynx preceded the propagated pharyngeal contraction and registered manometrically as a slight intrabolus pressure before the major pressure complex. Contraction in the horizontal plane began after bolus head transit and culminated with stripping of the bolus tail through the pharynx. Prolonged upper sphincter opening with the larger-volume swallows resulted from a delayed onset rather than altered propagation of the horizontal pharyngeal contraction. It is concluded that the propagated pharyngeal contraction facilitates pharyngeal clearance but has a minimal role in the process of bolus propulsion during swallowing. The propagated contraction works in concert with profound pharyngeal shortening to minimize hypopharyngeal residue after a swallow.

Adult↗
PubMed1992

Role of nitric oxide in lower esophageal sphincter relaxation to swallowing.

Studies were performed in the opossum to define the role of the L-arginine-nitric oxide (NO) pathway in lower esophageal sphincter (LES) relaxation to swallowing and vagal stimulation in viv and intramural nerve stimulation in vitro. In vivo, L-NAME, a water soluble NO synthase (NOS) inhibitor, caused antagonism of LES relaxation due to reflex-induced swallowing. L-NAME (20 mg/kg i.v.) reduced the amplitude of swallow induced relaxation from 88% to 28%. LES relaxation due to electrical stimulation of peripheral end of decentralized vagus nerve was also antagonized. The effects of L-NAME were reversed by L-arginine, but not by D-arginine. L-NAME treatment did not antagonize LES relaxation to intravenous administration of isoproterenol. In vitro, NO and sodium nitroprusside (SNP) caused a decrease in the sphincter tone. The relaxing effect caused by NO and SNP was not antagonized by tetrodotoxin or omega-conotoxin. Inhibitors of NO synthase, L-NMMA and L-NNA, caused slight increase in the spontaneous resting LES tone and concentration-dependent antagonism of electrical field stimulation (EFS) induced LES relaxation. L-NNA (10(-4)M) abolished EFS induced LES relaxation at low frequencies (less than 5 Hz) and antagonized the relaxation to a value 20% of the control at 20 Hz. The antagonistic action of L-NMMA and L-NNA was unaffected by D-arginine but was reversed by L-arginine. The inhibitory effect of NO, SNP, or two other putative inhibitory neurotransmitters (VIP and CGRP) on the LES was not antagonized by L-NNA. These studies show that inhibitors of NO synthase selectively antagonize LES relaxation to all three modes of intramural inhibitory nerve stimulation including physiological swallowing. These studies suggest that the L-arginine-nitric oxide pathway is involved in physiological relaxation of the LES.

Amino Acid Oxidoreductases↗
PubMed1994

Reproductive success of barn swallows nesting near a selenium-contaminated lake in east Texas, USA.

Reproductive success and contaminant levels in 1986 and 1987 were compared between Barn Swallows nesting at selenium-contaminated Martin Lake, Texas, USA, and swallows nesting at a reference site. Nests were initiated about the same time or earlier at Martin Lake than at the reference site and clutch size was similar between the two locations. Nest success was significantly higher at Martin Lake than at the reference site and no embryo or chick deformities were documented. Selenium concentrations in 14 of 20 eggs from Martin Lake were above background (> 3 ppm, dry weight); two of 20 eggs contained > 5 ppm, a concentration associated with a 20% embryo mortality/deformity rate in some bird species. Selenium concentrations in the kidneys of adult swallows were higher at Martin Lake (mean = 14 ppm dry weight) than at the reference site (5.8 ppm). DDE, the only detected organochlorine compound, was in two of 10 eggs from Martin Lake; these concentrations were below those associated with chronic poisoning and reproductive problems. The maximum mercury concentration in livers of adult Barn Swallows (0.83 ppm, dry weight) was within the range for background levels (< 5 ppm).

Journal Article↗
PubMed2005

Influence of mastication and salivation on swallowing in stroke patients.

OBJECTIVE: To determine differences of the oral swallowing functions between stroke and normal subjects and to identify those factors affecting dysphagia of stroke patients. DESIGN: Case-control study. SETTING: University hospital. PARTICIPANTS: Ten stroke and 10 healthy subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Resting saliva flow rate, the total number of chews, and the duration of the oral phase until onset of pharyngeal swallow, and food viscosities both before and after the oral phase using diluted barium, pudding, thick rice gruel, and curd type yogurt. RESULTS: The viscosity of all test foods was significantly reduced after the oral phase in both groups (P<.01). Resting saliva flow rate and the viscosity of thick rice gruel after the oral phase in the stroke group were significantly lower than in the control group (P<.01). However, there were no differences in the viscosities of the other foods between both groups. And a longer oral phase and a greater number of chews prior to pharyngeal swallow were revealed in the stroke group than in the control group (P<.01). CONCLUSIONS: This study shows that the food requiring mastication demands a longer oral phase and a greater number of chews, and has more altered rheologic characteristics during the oral phase in stroke patients. These findings suggest that masticatory function is impaired in stroke patients, which may contribute to their swallowing dysfunction.

Aged↗
PubMed2006

An analysis of lingual contribution to submental surface electromyographic measures and pharyngeal pressure during effortful swallow.

OBJECTIVE: To evaluate the influence of tongue-to-palate pressures on submental muscle contraction and oral and pharyngeal pressure dynamics during effortful swallowing maneuver. DESIGN: Comparative analysis of 2 task strategies on biomechanic measures of swallowing. SETTING: Research laboratory in a free-standing research facility. PARTICIPANTS: Consecutive volunteer sample of 20 healthy participants (age range, 20-35 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak amplitude of submental surface electromyography and orolingual and pharyngeal manometric pressure at 4 locations. RESULTS: General linear model analysis of variance revealed statistically significant greater amplitudes for the tongue emphasis condition of effortful swallow at all measured sensors (P<.004). CONCLUSIONS: Tongue-to-palate emphasis during execution of effortful swallowing increases amplitudes of submental surface electromyography, orolingual pressure, and upper pharyngeal pressure to a greater degree than a strategy of inhibiting tongue-to-palate emphasis.

Adult↗
PubMed2006

The use of the Gaussian curve fitting method for scintigraphic measurements of the swallowing process in healthy subjects: implications for evaluation of dysphagia.

OBJECTIVE: To present the results of scintigraphic evaluation, using the Gaussian curve fitting method, via 3 parameters of oropharyngeal swallow: (1) pharyngeal transit time, (2) premature pharyngeal entry, and (3) postswallow pharyngeal stasis while ingesting liquid. DESIGN: A descriptive study. SETTING: A rehabilitation hospital affiliated with a medical university. PARTICIPANTS: Eighteen healthy subjects. INTERVENTION: All 18 subjects received scintigraphic swallow examination to evaluate dynamic swallow process of 5 mL of liquid. MAIN OUTCOME MEASURES: The Gaussian curve fitting method was used to calculate the pharyngeal transit time, premature pharyngeal entry, and postswallow pharyngeal stasis. RESULTS: The mean pharyngeal transit time was .71 seconds. The maximal percentage of premature pharyngeal entry was 3%. The maximal percentage of postswallow pharyngeal stasis was 9%. CONCLUSIONS: The Gaussian curve fitting can be used as an objective and time-saving method to calculate the parameters in scintigraphic swallowing examination. Our results approximate other researchers' reports.

Aged↗
PubMed2004

Induction of long-term plasticity in human swallowing motor cortex following repetitive cortical stimulation.

OBJECTIVE: The excitability of corticobulbar projections to swallowing musculature undergoes remarkable long-term increases after short periods of pharyngeal stimulation. The aim of this study was to investigate the excitability of swallowing motor cortex following repetitive transcranial magnetic stimulation (rTMS). METHODS: Twelve healthy subjects were given 100 rTMS pulses over motor cortex at frequencies of 1, 5 and 10 Hz at an intensity of 80% threshold for corticobulbar activation. The excitability of the corticobulbar projection was assessed before and after rTMS and compared both to sham stimulation and to the corticospinal projection. RESULTS: Stimulation at 5 Hz, but not 1 Hz, 10 Hz or sham stimulation increased the excitability of the corticobulbar projection to the pharynx, reaching a peak 60 min after rTMS (Delta increase: 65%, P=0.016). Excitability in the projection from the opposite hemisphere also increased, suggesting the presence of inter-hemispheric interactions, whereas excitability in the projection to thenar muscles was unchanged. CONCLUSIONS: Corticobulbar and corticospinal projections may differ in response to rTMS, implying differences in relative thresholds of inhibitory and excitatory elements in hand versus swallowing cortex. SIGNIFICANCE: This might be a useful approach in the motor rehabilitation of dysphagic stroke patients who have damage to sensory projections to the swallowing cortex.

Adult↗
PubMed2005

Evaluation of swallowing disorders with videofluoroscopy in Austria: a survey.

AIM: The aim of our study was to assess the availability of videofluoroscopy to examine patients with swallowing disorders in Austria. MATERIALS AND METHODS: A questionnaire was sent to the department heads of the radiology departments of all hospitals (n=143) and to all non-hospital-based radiologic practices (n=226) throughout Austria. The survey focused on the availability of videofluoroscopic swallowing studies and on the studies performed in patients with deglutition disorders. RESULTS: The questionnaire was completed and returned by 134 of 143 radiology departments (94%) and 65 of 226 non-hospital-based radiologists (29%). Videofluoroscopic swallowing studies were performed in 38 of 134 radiology departments (28%) and in 21 of 65 practices (32%). The method is available in all nine Austrian states (100%) and 27 of 99 districts (27%). The number of examinations performed in different states ranged from 0.7 to 19 studies/10,000 population per year. The number of videofluoroscopic examinations per department or practice in the year 2001 ranged between 5 and 690 (median, 100 examinations). To 85% of videofluoroscopy units patients were referred from otorhinolaryngology/phoniatrics-logopedics, to 69% of videofluoroscopy units referrals were also from internal medicine, from neurology in 54%, and from pediatrics in 20%. CONCLUSION: Despite the widespread availability of videofluoroscopy throughout Austria, its use still varies largely between different states. The data show that in general there is a wide-spread demand for videofluoroscopic swallowing studies.

Austria↗
PubMed2006

Videomanometry reveals clinically relevant parameters of swallowing in children.

OBJECTIVE: The aim of this pilot study is to demonstrate the technical and clinical feasibility of videomanometry to assess swallowing in infants and young children presenting with dysphagia. METHODS: We performed videomanometry using a combined solid state catheter and a perfused manometric sleeve assembly in eight patients (2-28 months) presenting at a tertiary care institution with symptoms of dysphagia. Solid state sensors were positioned at the inferior margin of the valleculae and the laryngeal entrance and the upper esophageal sphincter sleeve assembly was positioned across the upper esophageal sphincter. Manometric and radiological data were digitally recorded simultaneously using a manofluoromixer. Liquid bolus swallows were recorded in each patient and different geometric parameters of deglutition were measured. RESULTS: Placement and fixation of the catheter was well tolerated and no adverse effects occurred. The children easily swallowed test boluses as selected during clinical examination. Results indicate that pharyngeal contractility can be evaluated as well as relaxation of the upper esophageal sphincter during swallowing of wet boluses. CONCLUSIONS: Videomanometry in young children is feasible with the limited discomfort of the placement of the catheter. It is a promising technique that will allow more accurate assessment of pediatric oropharyngeal dysphagia.

Child, Preschool↗
PubMed2005

Videofluoroscopic assessment of swallowing function in patients with myasthenia gravis.

Swallowing function in myasthenia gravis (MG) was investigated by videofluoroscopy (VF). A total of 23 VF examinations were performed on 11 MG patients at various time points over the exacerbation and remission stages of disease. The assessment parameters on VF examination are set as follows: bolus transport from the mouth to the pharynx, bolus holding in the oral cavity, velopharyngeal seal, tongue base movement, pharyngeal constriction, laryngeal elevation, upper esophageal sphincter (UES) opening, and bolus stasis at the pyriform sinus (PS). Aspiration was also assessed on VF examination. Aspiration was seen in 34.8%, and half of these cases involved silent aspiration. Three of four cases that showed silent aspiration went on to experience aspiration pneumonia during the follow-up term. By Spearman's rank correlation, disturbance of laryngeal elevation was significantly correlated with aspiration (p=0.001), and incomplete UES opening was not significantly, but tended to be, correlated with aspiration (p=0.067). Although other parameters in the oral and pharyngeal phase on VF examination, such as bolus transport from the oral cavity to the pharynx, pharyngeal constriction, or stasis at the PS, were remarkably disturbed (in more than 50% of the examinations), those parameters were not good indicators for aspiration. When a disturbance of laryngeal elevation is found at a bedside clinical test, we recommend performing precise swallowing evaluation, such as VF, Fiberoptic Endoscopic Evaluation of Swallowing (FEES), and/or scintigraphic assessment of swallowing, for MG patients, to detect silent aspiration.

Adolescent↗
PubMed2004

Membrane potential changes in vocal cord tensor motoneurons during breathing, vocalization, coughing and swallowing in decerebrate cats.

We studied the patterns of membrane potential changes in vocal cord tensor motoneurons, i.e. cricothyroid muscle motoneurons (CTMs), during fictive breathing, vocalization, coughing, and swallowing in decerebrate paralyzed cats to determine the nature of central drives to CTMs during these behaviors. CTMs were identified by antidromic activation from the superior laryngeal nerve. During breathing, CTMs always depolarized during the inspiratory phase, and sometimes depolarized during the expiratory phase as well. During vocalization, CTMs strongly depolarized. During coughing, CTMs exhibited depolarizations during both inspiratory and expiratory phases, but it was interrupted by a transient repolarization between the last part of the inspiratory phase and the first part of the abdominal burst during which chloride-dependent inhibitory postsynaptic potentials were revealed. During swallowing, most CTMs hyperpolarized, and this hyperpolarization was sometimes followed by a weak depolarization. We conclude that the main role of the cricothyroid muscle is vocalization but the functional roles in coughing and swallowing are minor, and that the CTM activity during resting breathing and vocalization are primarily controlled by excitatory inputs, while during coughing and swallowing, inhibitory inputs play roles in shaping membrane potential trajectories.

Analysis of Variance↗
PubMed2004

The efficacy of palatal augmentation prostheses for speech and swallowing in patients undergoing glossectomy: a review of the literature.

This article provides a review of the literature to assist the clinician in determining the efficacy of palatal augmentation prosthesis regarding speech and swallowing for the patient undergoing glossectomy. A MEDLINE search was conducted. Peer-reviewed articles published from 1966 to July 2002 that addressed the question of the efficacy of this prosthesis to improve speech and swallowing after partial or total glossectomy were included. Studies reviewed had to incorporate an objective evaluation of one or both functions. Nine of 130 studies met the selection criteria (4 retrospective, 1 case control, and 4 case reports). A total of 50 subjects were studied, 42 for swallowing and 37 for speech. In 36/42 subjects, treatment was advantageous for swallowing and in 32/37 subjects, it was advantageous for speech. On the basis of the limited evidence available, the functional efficacy of the palatal augmentation prosthesis is supported.

Case-Control Studies↗
PubMed2006

Nutritive and non-nutritive swallowing apnea duration in term infants: implications for neural control mechanisms.

The impact of bolus ingestion and level of consciousness on swallowing apnea duration (SAD) in healthy term infants has not been adequately explored despite the likely contribution of swallowing apnea to upper airway protection against aspiration. SAD during wakefulness, sleep, and feeding (breast or bottle) of 10 term infants was measured 10 times from birth to 1 year of age. Nineteen thousand four hundred and two swallows were analyzed. Irrespective of age, SAD during feeding was significantly shorter than SAD of non-nutritive swallowing (during wakefulness and sleep). SAD did not change significantly within the first year of life in any of the three conditions and there was no change in the relative durations of nutritive, wake and sleep conditions with age. The absence of an age effect implies that the neural mechanisms controlling SAD are fundamentally brainstem-mediated and largely hard-wired at birth in healthy term neonates.

Aging↗