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PubMed1983

The relationship of the 'inferior constrictor swallow' and 'globus hystericus' or the hypopharyngeal syndrome.

The term 'Globus Hystericus' is considered to be a very bad term for such a common condition and it is recommended that it be replaced by the 'Hypopharyngeal Syndrome'. The normal modified swallow initiated from the lingual tonsil--epiglottis area, called the Inferior Constrictor Swallow, can cause all the symptoms. The epiglottis does not bend. There are two groups of symptoms: the first due to sensation from local irritation of the lingual tonsil; and the second due to vicious circles causing increased muscle tension and strain swallowing. If there is pain or dysphagia or impairment in swallowing, then it is not the Hypopharyngeal Syndrome. The key-note of treatment is the logical explanation of these symptoms and that the vicious circles must be broken.

Adolescent↗

PubMed2005

Swallowing dysfunction in patients with unilateral vocal fold paralysis: aetiology and outcomes.

Although unilateral vocal fold palsy (UVFP) is a common problem, data relating to swallowing dysfunction are sparse. We reviewed the clinical findings (method of presentation, underlying diagnosis and position of the vocal folds) of 30 patients and conducted a follow-up telephone survey. Outcome measures used were direct visualization of fold function, position and compensation. In addition, standardized speech and language assessments for swallowing dysfunction and dysphonia were noted and compared to presentation. Our study indicates that 56 per cent of patients with UVFP have associated dysphagia. Outcome with speech therapy is significant, with 73 per cent showing improvement. These data indicate a significant link between UVFP and swallowing dysfunction. There is a marked therapeutic benefit from voice therapy. Further work is required to evaluate the long-term outcomes and establish the mechanism of swallowing dysfunction in these patients.

Adult↗

PubMed2001

The effects of experimental reservoir creation on the bioaccumulation of methylmercury and reproductive success of tree swallows (Tachycineta bicolor).

Reservoir creation results in decomposition of flooded organic matter and increased rates of mercury methylation. Methylmercury (MeHg), the most toxic form of mercury, bioaccumulates through aquatic food webs. Our objective was to quantify the transfer of MeHg from aquatic food webs into terrestrial organisms. We examined rates of MeHg bioaccumulation in an insectivorous songbird, the tree swallow, breeding near an experimentally created reservoir. We also determined the impact of flooding and MeHg bioaccumulation on the reproductive success of these birds. Mean MeHg burdens in nestling swallows from near the experimental reservoir increased from 1,210 +/- 150 ng before flooding to 2,200 +/- 102 ng after flooding. Postflood MeHg concentrations in both the body and feathers of the birds were significantly greater than preflood MeHg concentrations. Although MeHg burdens in swallows were elevated in postflood years, we found no overt toxicological affects. An increase in dipteran productivity (the primary food source of tree swallows) after reservoir creation resulted in earlier nest initiation, larger eggs, and faster growth rates of wing and bill length in nestlings raised during postflood years.

Animals↗

PubMed2003

Simultaneous real-time measurements of mastication, swallowing, nasal airflow, and aroma release.

Mastication, swallowing, breath flow, and aroma release were measured simultaneously in vivo using electromyography, electroglottography, a turbine air flow meter, and the MS-Nose, respectively. Signals were synchronized either electronically or by aligning the nasal airflow data with the breath by breath release of acetone. Chewing affected nasal airflow, with the flow fluctuations following the mastication pattern. Data analysis suggested that air was pumped out of the mouth into the throat with each chew, and the mean volume was 26 mL. Aroma release was associated with the pulses of air pumped from the mouth with each chew. During swallowing, there was no nasal airflow, but after swallowing, aroma release was evident. The volume of the retronasal route was estimated at 48 mL when swallowing and 72 mL when samples were chewed. The combination of techniques shows the effects of physiological processes on aroma release.

Deglutition↗

PubMed2001

Role of nitric oxide during swallow-induced esophageal shortening in cats.

Swallowing induces esophageal shortening due to contraction of the longitudinal muscle (LM) layer. Experiments in the opossum have shown an excitatory effect of nitric oxide (NO) on esophageal LM strips. We evaluated the role of NO in swallow-induced esophageal shortening and assessed the effect of NO in vitro on feline LM strips. Swallow-induced esophageal shortening was studied before and after NO synthase blockade with L-NAME. In five cats esophageal shortening was measured using two endoscopically affixed mucosal clips. In another five cats LM contraction was measured by a strain gauge sutured on the serosal side at 2 cm above the LES; muscle strips from that region were obtained for in vitro studies. Swallowing induced esophageal shortening of 48.3+/-8.3% and LM contraction of 4.4+/-0.8 g in the control period and 32.1+/-8% and 3.0+/-0.4 g after L-NAME (P < 0.05). Nitric oxide and SNP did not change the basal tone of esophageal LM strips but provoked inhibition of metacholine-induced tonic and phasic activity. Electrical field stimulation induced frequency-dependent contractions that were reduced by atropine without further reduction after L-NAME. In conclusion, the reduction of esophageal shortening after L-NAME during the in vivo experiments suggested an excitatory effect of NO on the feline esophagus. The in vitro experiments, however, showed no contractile effect of NO or SNP on LM strips, but an inhibitory effect on the precontracted tissue. The influence of NO synthase blockade on in vivo esophageal LM shortening might be secondary to its effect on circular muscle contractility.

Animals↗

PubMed1999

Esophageal swallowing phase assessed by audiosignal recording: relationship with manometry in gastroesophageal reflux disease patients.

The acoustic technique has been used for pharyngeal exploration but to date no such technique has been devised to assess esophageal motility. The aim of this study was to demonstrate that displacement through the esophagus can be quantified using this method in healthy subjects and in patients with gastroesophageal reflux. Concurrent manometric and acoustic recordings were also performed in the patients. Fifteen controls (38.5 +/- 13 years old) and 10 patients (34.9 +/- 6 years old) were included. All were recorded during wet and dry swallow sequences with microphones placed below the cricoid cartilage and on the xiphoid appendix. Standard manometry was performed for lower esophageal sphincter (LES) exploration. For the acoustic technique, the frequency of xiphoid signals (FX), esophageal transit time (ETT), duration of xiphoid sound (SD), and for the manometric study, the duration of LES relaxation (RD) were recorded and mean values were calculated (FXm), (ETTm), (SDm), (RDm). FXm for wet (94 vs 81.6%) and dry swallows (86 vs 66.6%) decreased in patients. ETTm was significantly higher (P < 0.01) for wet than for dry swallows (5.6 +/- 0.9 vs 5.2 +/- 1.2 sec) for controls but not for patients. ETTm was significantly higher for patients for wet (7.2 +/- 2.1 sec) and for dry swallows (6.5 +/- 2.3 sec) than for controls and SDm was lower. Xiphoid sound appeared in the second half of LES relaxation. Our noninvasive acoustic technique is simple and reproducible. It is well correlated with manometry, and it allows characterization of the displacement of the bolus through the esophagus and the LES. The technique could be used alone to determine appropriate pharmacological and surgical treatments for esophageal motility disorders.

Acoustics↗

PubMed1992

Mastication and swallowing: an overview.

The cycles of jaw and tongue movement during feeding produce not only the breakage of food but its intra-oral transport; which activity predominates depends upon the physical characteristics of the food. When hard food is eaten and tooth-food-tooth contact is made during jaw closure, the velocity of closing is suddenly reduced, producing two clearly different phases of closure; during the second phase the activity of the jaw closing muscles is much increased. Conversely, in cycles with a mainly transport function (eating soft food), the antero-posterior movements of the tongue are much greater; this alters the time and rate at which the jaw opens. The pattern of jaw movement during closing and during opening consequently varies with food consistency. The evidence suggests that sensory input controls the form of the cyclical tongue and jaw movements. However the basic plan of movement is produced by the activity of a brainstem pattern generator which receives input from both cerebro-cortical and peripheral sources. The swallow that occurs in normal feeding consists of the equivalent of the classical second stage of swallowing inserted into the occlusal or initial jaw opening phase of an otherwise standard cycle. Although leakage of traces of food or saliva into the vallecula appears to be a peripheral sensory input of major importance in inducing such a swallow, the execution of the swallow is due to a pattern generator in the brainstem.

Bite Force↗

PubMed1976

Facial morphology and activity of temporal and lip muscles during swallowing and chewing.

The correlations between facial and bite morphology and the activity in the temporal muscle and in the musculature of the lip during swallowing and chewing were studied in 50 girls, aged 9-13 years. The activity was recorded electromyographically by determining the maximal mean voltage amplitude and morphologically by analysis of profile roentgenograms and dental casts. The activity in the lower lip during the swallowing was not correlated with any of the variables of the facial morphology with the exception of the width of the upper dental arch. On the other hand, the activity of the upper lip during swallowing, as in the anterior and posterior portions of the temporal muscle, was correlated with a number of variables used for measuring facial form. The activity was low in girls with a facial shape with anterior inclination of the maxilla and mandible, small face height, and pronounced prognathism. The activity in the upper lip during chewing varied, as in the lower lip, independently of facial form, while the activity of the temporal muscle during chewing showed the same relation to facial form as during swallowing. The number of chewing cycles required for trituration of the test media (apples and peanuts) was negatively correlated with the number of teeth and with age. This was interpreted as adaptation in such a way that the number of cycles decreased with development of the dentition.

Adolescent↗

PubMed1996

Interjudge agreement in videofluoroscopic studies of swallowing.

Videofluoroscopic swallowing examinations of 3 patients with dysphagia were reviewed independently by 10 speech-language pathologists. Prior to viewing each video, clinicians were provided with information about the patient's history, the results of a bedside swallow examination, and oral-facial and oral motor control examinations. Clinicians completed a swallowing observation protocol as they viewed each video. They then recommended, from a list of treatment strategies, intervention techniques that would be most appropriate for each patient. Interjudge agreement was calculated by determining how many clinicians observed a given swallowing event or deficit, and how many recommended a given treatment strategy. Results suggest that the level of interjudge agreement for videofluoroscopic evaluations is not encouragingly high.

Barium↗

PubMed2001

Screening swallowing function of patients with acute stroke. Part one: Identification, implementation and initial evaluation of a screening tool for use by nurses.

Stroke is a major cause of acute and chronic disability in the developed world, producing a wide range of impairments, including dysphagia, which impact upon eating. Dysphagia affects between one and two thirds of patients with acute stroke, with the potential for life-threatening airway obstruction, aspiration pneumonia and malnutrition. Whilst associated with increased impairment, dysphagia may present in isolation or accompanied by minimal disability; universal screening of swallowing function is recommended. This study describes the process undertaken to review the evidence for dysphagia screening methods in patients with acute stroke. It also identifies, implements and establishes sensitivity and specificity of a screening tool (the Standardized Swallowing Assessment, SSA) for use by nurses. Not all ward staff had completed training to use the SSA by conclusion of the patient audit. Nonetheless 123 out of 165 assessable patients (74.5%) had their swallow function screened, 64 by SSA (52%). Based on 68 completed screening episodes by independently competent nurses, a comparison with summative clinical judgement of swallow function revealed a sensitivity of 0.97 and specificity of 0.9 for detection of dysphagia, with positive and negative predictive values of 0.92 and 0.96. This was significantly better than gag reflex performance, supporting the use of the SSA by competent ward nurses.

Acute Disease↗

PubMed1998

Swallows, oesophageal and gastric motility in normal subjects and in patients with gastro-oesophageal reflux disease: a 24-h pH-manometric study.

BACKGROUND: the motor aspects underlying gastro-oesophageal reflux disease (GORD) are still not completely clear. AIM: to evaluate the relationship between oesophageal and gastric motility in GORD patients. PATIENTS: twelve patients with grade I-II oesophagitis, mean age 45 yr, and 10 healthy subjects, mean age 42 yr, were studied. METHODS: a pH-manometry was performed to analyse oesophageal and gastric motility, swallows and oesophageal pH values for the whole 24-h period, and for the 2-min period before and after each reflux episode. RESULTS: as compared to controls, GORD patients showed in the 24-h period, a greater number of swallows (P < 0.01) and a lower percentage of post deglutitive propagated oesophageal body waves (P < 0.05). The number of migrating motor complexes (MMC) was similar in the two groups, with a lower amplitude of phase III gastric waves in GORD. During MMC reflux episodes were seen only in GORD patients. After refluxes an increase in swallows, simultaneous and secondary oesophageal waves were detected in GORD patients, with a reduction of primary peristalsis. Isolated gastric contractions preceded reflux episodes more frequently in GORD patients than in controls. CONCLUSIONS: GORD patients showed an increase in swallows with altered post-deglutitive oesophageal motility and a reduced amplitude of gastric MMC. Moreover small contractions of gastric antrum are present before acid refluxes, suggesting a multifactorial pathogenesis of the disease.

Adult↗

PubMed2000

Motions of the posterior pharyngeal wall in human swallowing: a quantitative videofluorographic study.

OBJECTIVE: To quantify segmental motions of the posterior pharyngeal wall during swallowing. DESIGN: Prospective study. SETTING: Hospital radiology suite. PARTICIPANTS: Six healthy adult volunteers. INTERVENTIONS: Videofluorography of the pharynx in posteroanterior and lateral projections during water swallows by 6 able-bodied adults. Radiopaque suction markers, inserted through the nose, were attached by suction to the midline of the posterior pharyngeal wall of the upper and lower oropharynx, pharyngoesophageal segment (PES), or cervical esophagus. MAIN OUTCOME MEASURES: Displacement of the larynx, hyoid bone, and markers. RESULTS: Marker pathways were ovoid in the oropharynx but linear in the PES and esophagus. Marker displacement was greatest in the vertical dimension, intermediate in posteroanterior dimension, and smallest in mediolateral dimension. Vertical displacement was greater for the PES marker than for larynx, hyoid bone, or oropharynx markers (p < .001), so that the pharynx shortened significantly during each swallow. Marker displacement was unaffected by bolus volume. CONCLUSIONS: The pharyngeal wall shortened during swallowing. The mechanism for PES elevation may differ from that of laryngeal elevation. Shortening of the pharynx may be produced by contraction of the pharyngeal suspensory muscles and traction on the larynx by suprahyoid muscles.

Adult↗

PubMed1999

Relating speech and swallow function to dropout in a longitudinal study of head and neck cancer.

The relation between functional outcome and dropout from a 12-month follow-up period was examined in a longitudinal study whose objective was to define and quantify the functional effects of oral surgical resection and reconstruction on speech and swallowing in patients with head and neck cancer. In a group of 150 patients recruited to a surgical study in the Cancer Control Science Program in Head and Neck Cancer Rehabilitation, dropout from all causes and dropout from specific causes (medical, patient, and administrative specific) were assessed in relation to longitudinal speech and swallow function. In univariate analysis, better speech articulation was associated with decreased risk of dropout from all causes and from medical-specific causes. Better swallow performance was associated with decreased risk of medical-specific dropout. Multivariate analysis revealed the following: (1) only articulation function was associated with dropout from all causes; (2) the association of speech articulation function with medical dropout was diminished after adjusting for advanced age and surgical resection variables; (3) the association of speech articulation function became significant for patient-specific dropout after adjusting for advanced age and surgical resection variables and indicated that better function decreased the risk of this type of dropout; and (4) swallowing function was not related to dropout. Patients treated for oral or oropharyngeal cancer who have poorer speech outcomes are more likely to drop out from a longitudinal study. Basing study results on only patients who complete a longitudinal study will understate the level of dysfunction experienced.

Adult↗

PubMed1990

[Video fluoroscopy of the swallowing act following partial supraglottic laryngectomy].

Videofluoroscopy of swallowing was performed in 21 patients who had undergone partial horizontal laryngectomy. Food residues were present in most of these patients. Residues of liquid contrast were observed in 85.7% of the patients and residues of consistent contrast in 61.5% of the patients. In most cases, food remnants were to be found in the glossolaryngeal recess. The mechanisms of compensation, additional swallowing, and expiration after swallowing are an important factor in clearing the throat of any residual food. Impaired clearing of food residues results in aspiration. Aspiration of liquid contrast was observed in 76.2% of the patients and aspiration of consistent contrast in 19.1% of the patients (p less than 0.001). Aspiration after swallowing was observed in most of the patients.

Aged↗

PubMed2002

Motor dysfunction of the upper digestive tract in Pierre Robin sequence as assessed by sucking-swallowing electromyography and esophageal manometry.

OBJECTIVES: To evaluate motor dysfunction in infants with Pierre Robin sequence (PRS) who manifest upper airway obstruction and congenital dysphagia. STUDY DESIGN: Term infants (n = 28) with nonsyndromic PRS were studied between days 15 and 45. Sucking-swallowing electromyography was used to evaluate suction and coordination between the oral and pharyngeal phases of swallowing. Esophageal manometry was used to study the lower esophageal sphincter, esophageal body, and upper esophageal sphincter functions. Manometry results were compared with those of 16 infants with gastroesophageal reflux disease (GERD). RESULTS: Electromyography showed incoordination of sucking and swallowing in 24 of 28 patients. The disorder was mild in 6, moderate in 6, and severe in 12 patients. All patients showed manometry disturbances: incomplete or asynchronous lower sphincter relaxation (15), multipeaked esophageal body waves (17), very high amplitude waves (14), and asynchronous upper sphincter relaxation (19). The frequency of disturbances and mean resting pressures of both lower and upper sphincters were significantly higher than GERD patients. CONCLUSION: In Pierre Robin sequence, sucking-swallowing electromyography and esophageal manometry reveal dysfunction in the motor organization of the tongue, the pharynx, and the esophagus.

Electromyography↗

PubMed1998

Health of tree swallows (Tachycineta bicolor) nesting in pesticide-sprayed apple orchards in Ontario, Canada. II. Sex and thyroid hormone concentrations and testes development.

To investigate the effects of pesticides on wild birds, sex (17beta-estradiol; testosterone) and thyroid (triiodothyronine (T3) hormone concentrations, body mass, and testes mass were measured and the development of testes was evaluated in wild tree swallows (Tachycineta bicolor) nesting in four sprayed apple orchards and three nonsprayed sites in southern Ontario, Canada, in 1995-1996. In orchards, birds were exposed to asmany as 11 individual spray events and five sprays of mixtures of chemicals. Residues of organochlorine pesticides, PCBs, lead, and arsenic concentrations were low and not variable among sites except p,p'-DDE concentrations, which ranged from 0.36 to 2.23 microg/g wet weight in eggs. These persistent compounds were not correlated with any endocrine response measured in tree swallows. In 16-d-old male tree swallow chicks, body mass and concentrations of 17beta-estradiol (estradiol), testosterone, and T3 in plasma showed no significant differences between sprayed and nonsprayed groups and among sites within those groups. However, T3 concentrations were slightly elevated in the sprayed group compared to the nonsprayed group, and there was a significant and positive correlation between T3 and the number of mixtures of sprays applied during egg incubation through chick rearing. In 16-d-old female chicks, there were no significant differences among spray treatments or sites and no correlations with spray exposure for testosterone, estradiol, or T3 in plasma. Body mass was correlated positively with T3 and negatively with estradiol but showed no differences among spray exposure groups or sites. Histology of testes of 16-d-old male chicks indicated there were no significant differences among sprayed and nonsprayed birds in testes mass, area, or diameter, or the presence of Leydig cells in the interstitium, the distribution of the Sertoli cells, or the occurrence of heterophils in the testicular interstitium. For the percentage of spermatogonia present on the basement membrane, there were significant differences among sites, but these differences were not specifically associated with spray exposure. However, there was a marginally significant trend between increasing occurrence of a disrupted Sertoli cell population on the seminiferous tubular basement membranes as the number of mixtures of pesticides sprayed during chick rearing increased. In adult male and female parent tree swallows, there were no differences in hormone concentrations between birds from sprayed and nonsprayed sites. Nor were there any significant correlations between the concentration of any hormone and collection date, body mass, or any type of spray exposure for adults. The correlations between increasing pesticide exposure and abnormal thyroid hormone and testes development in male chicks indicate that further reductions of pesticide use in orchards may benefit the health of birds that nest there. However, it is unclear which of these pesticides or spray mixtures are responsible for these effects, and this needs to be examined in future studies.

Animals↗

PubMedDate not supplied

Quantitative lingual, pharyngeal and laryngeal ultrasonography in swallowing research: a technical review.

Because of its distinct advantage in radiation-free soft tissue imaging, ultrasonography has been widely used to study lingual, pharyngeal, hyoid, laryngeal, and even esophageal action during swallowing in individuals of all ages. Qualitative ultrasonographic observations have made considerable contributions to our understanding of deglutition. Quantitative ultrasonographic swallowing research has also grown by leaps and bounds over the years with advances in imaging technologies and analytical methodologies. As a technical primer for new investigators, this paper reviews the modem methods for quantitative analysis in ultrasonographic swallowing research. The intended outcome is a basic understanding of the application of ultrasonography with various analysis options to the quantitative study of the deglutitive action of selected upper aerodigestive structures. Though proven useful for swallowing research, ultrasonography has inherent limitations and methodological issues. Future technological advancement and sophisticated image processing and analysis algorithms will resolve some of these issues.

Biomechanical Phenomena↗

PubMed1998

Videomanometry of the pharynx in dysphagic patients with laryngeal barium penetration during swallowing.

PURPOSE: This study used simultaneous videomanometry to measure pressure characteristics in a group of patients with evidence of laryngeal and/or tracheal barium penetration, and to compare the results to those of one group of healthy volunteers and one group of patients with dysphagia but a normal barium swallow. MATERIAL AND METHODS: Videomanometry during barium swallowing was performed in 25 patients who showed penetration of barium into the laryngeal vestibule. Manometric abnormalities were determined by comparing these mean values with those of 25 healthy volunteers, and the frequency of manometric abnormalities was compared to that of 19 patients presenting with oropharyngeal dysphagia with a normal barium swallow. RESULTS: The frequency of abnormalities for four parameters (pharyngo-esophageal segment (PES) resting pressure, PES relaxation duration, pharyngeal peak pressure, pharyngeal contraction duration) differed significantly between the patients with penetration and those with normal barium studies. There was, however, no association between manometric abnormalities and the degree of barium penetration. CONCLUSION: The differences in manometric abnormalities between patients with laryngeal penetration and patients with normal barium swallows may be useful in identifying the mechanisms of laryngeal penetration.

Adult↗