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PubMed1991

Influence of occlusal splints on bilateral anterior temporal EMG activity during swallowing of saliva in patients with craniomandibular dysfunction.

A full-arch maxillary stabilization occlusal splint was made for each of 10 patients with craniomandibular dysfunction. These splints were divided into three sections (one anterior and two posterior). This procedure allowed variation in the anteroposterior centric localization of occlusal contacts, thus permitting the recording of the EMG effects produced by the different occlusal splint sections. The integrated EMG activity was recorded from the right and left anterior temporal muscles during swallowing of saliva in habitual occlusion and with the different occlusal splint sections inserted. EMG activity during swallowing of saliva was significantly lower with the different occlusal splints than in habitual occlusion. This supports the rationale for diurnal wear of the occlusal splint. No differences in EMG activity were found during swallowing of saliva when different sections of the occlusal splints were used. This fact points out the possibility for therapeutic use of different occlusal splints for improving swallowing function.

Adolescent↗
PubMed2002

The distribution of respiration-related and swallowing-related motoneurons innervating the rat genioglossus muscle.

The present study was an attempt to identify the location of genioglossal respiratory and swallowing motoneuron cell bodies within the hypoglossal (XII) nucleus using both electrophysiological and morphological studies. The genioglossus muscle is innervated by the genioglossal branch of the medial XII nerve. At the entrance to the muscle, the genioglossal branch divides in the directions of the mandible and tongue. Five of five rats displayed both respiratory-related and swallowing-related bursts in the medial XII branch towards the mandible. All five rats also displayed swallowing-related bursts in the medial XII branch towards the tongue. In addition, horseradish peroxidase conjugated to wheatgerm agglutinin (HRP:WGA) was injected into the proximal cut ends of each branch. When HRP:WGA was injected into the branch in the direction of the mandible, HRP-labeled cells were detected in the lateral region of the ventromedial subnucleus in the XII nucleus, extending from 0.7 to 1.2 mm rostral to the obex. On the other hand, after injection into the branch in the direction of the mandible, HRP-labeled cells were detected in the ventromedial subnucleus of the XII nucleus, extending from 0.3 to 1.2 mm rostral to the obex. These results provide evidence that genioglossal respiration-related and swallowing-related motoneurons are located in different portions within the ventromedial subnucleus of the XII nucleus.

Animals↗
PubMed2003

Services for aphasia, other acquired adult neurogenic communication and swallowing disorders in the United Kingdom, 2000.

PURPOSE: We developed a questionnaire designed to determine the state of services provided by the National Health Service within the UK for adults with acquired neurologically caused communication disorders. A further aim was to compare our results with those from a similar survey conducted 10 years ago by Mackenzie et al. METHOD: We sent questionnaires to 264 managers and directors of adult speech and language therapy services in the UK. We asked questions about staffing levels, regional variations, patterns of service delivery at acute and chronic stages and staff time spent working with different communication and swallowing problems. RESULTS: Nearly 53% of average staff time was spent working with swallowing disorders accompanying neurological damage (dysphagia) compared to 24% with aphasia. As the percentage of time spent working with swallowing increased, the percentage of time spent working with aphasia reduced. Out of the time spent on aphasia treatment, 48% averages less than 3 h per week duration and just 4.8% averages more than 3 h per week, which was correlated with total number of speech and language therapists employed by a service. We found a significant difference only between London, with the highest total staff numbers, and the South West, with the lowest. We also found significant relationships between staff numbers and population size and staff numbers and the level of referrals to the service. CONCLUSIONS: Our main conclusions are: (1) while there may have been an increase in the number of speech and language therapists working with acquired and progressive neurogenic conditions in the past 10 years, they are mainly working with swallowing disorders, and (2) findings agree with recent studies showing that the amount of treatment or therapy that aphasic clients receive is well below that recommended by the literature.

Aphasia↗
PubMed2003

Videoradiographic analysis of how carbonated thin liquids and thickened liquids affect the physiology of swallowing in subjects with aspiration on thin liquids.

PURPOSE: To analyze how carbonated thin liquids affected the physiology of swallowing in dysphagic patients. MATERIAL AND METHODS: 40 patients were analyzed; 36 were neurologically impaired. During a therapeutic videoradiographic swallowing examination the patients had to swallow liquids with the following consistencies three times: thin, thickened and carbonated. The liquids were given in doses of 3 x 5 ml. The swallows were analyzed regarding penetration/aspiration, pharyngeal transit time and pharyngeal retention. RESULTS: Significant difference was found regarding penetration/aspiration when comparisons were made between thin liquid and carbonated thin liquid (p<0.0001). Carbonated liquid reduced the penetration to the airways. The comparison between thin liquid and thickened liquid (p<0.0001) showed significant less penetration with thickened liquids. Pharyngeal transit time was reduced both when comparing thin liquid with thin carbonated liquid (p<0.0001) and thickened liquid (p<0.0001). Pharyngeal retention was significantly reduced (p<0.0001) with carbonated thin liquid compared to thickened liquid. The comparison of thin liquids and carbonated thin liquids showed p=0.0013, thin and thickened liquids p=0.0097. CONCLUSIONS: Carbonated liquids reduced penetration/aspiration into the airways, reduced pharyngeal retention and pharyngeal transit time became shorter. Therefore, carbonated liquids are a valuable treatment option for patients with penetration/aspiration. Thickened liquids may still be an option for patients who cannot tolerate carbonated liquids and liquids with this consistency are safer than thin liquids.

Aged↗
PubMed1989

Respiratory patterns associated with swallowing: Part 1. The normal adult pattern and changes with age.

Simple, non-invasive equipment was designed to record respiratory patterns associated with swallowing food or drink in young and elderly healthy adults, to compare with neurologically impaired patients who complained of dysphagia. The timing of the entry of the test drink from a spoon into the mouth, the swallow event and respiration were recorded electronically and were presented in chart form. The equipment proved to be easy to use and the results were consistent. All 33 subjects showed a well-defined respiratory pattern, with individual minor variations, but different from the pattern of their resting respiration. The direction of respiration during spoon contact was consistent for each individual and the pharyngeal stage of swallowing was almost always followed by a large expiration. Thus the resting respiration is not simply arrested during swallowing, but is substituted by a different, well-controlled pattern.

Adult↗
PubMed1995

Oxygen desaturation on swallowing as a potential marker of aspiration in acute stroke.

We have assessed the measurement of oxygen saturation (SaO2) as a means of detecting aspiration in patients with stroke. For 10 weeks all acute stroke [AS] admissions were seen within 48 hours. Basal SaO2 was measured by pulse oximetry. Patients swallowed 10ml water while sitting up and SaO2 was noted for 2 minutes. Two control groups [young, fit (YF) and inpatient age- and sex-matched, non-neurological disease (IP)] underwent the same assessment. AS subjects underwent independent assessment of swallowing by a speech and language therapist (SLT). Exclusion criteria comprised impaired consciousness, other neurological disease and chest infection. Forty-nine AS subjects [20 men; aged 46-93 (mean 71) years], 55 YF [26 men; aged 18-55 (mean 32) years] and 65 IP [28 men; aged 53-96 (mean 71) years] were studied. Mean (SD) SaO2 fall in AS subjects [2.6 (2.9)%)] was significantly more than in YF [1.1 (0.8)%] or IP [1.1 (0.9)%]. The lower 95% confidence limit for variation in SaO2 did not differ between YF and IP (3.0% 'fall'); 19 (39%) AS subjects desaturated below this 95% lower confidence limit. Mean (SD) SaO2 fall was significantly more in SLT-graded 'aspirators' [4.6 (2.7)%] than 'nonaspirators' [1.4 (1.0)%]. We conclude that (1) a fall in SaO2 on swallowing fluid is common in patients with acute stroke; (2) the presence or absence of desaturation agrees statistically with SLT assessment of aspiration; (3) SaO2 measures may aid bedside assessment of swallowing.

Adolescent↗
PubMed1998

A comparison of barium swallow and erect esophageal transit scintigraphy following balloon dilatation for achalasia.

We evaluated the relationship between radionuclide esophageal transit studies and barium swallow appearances in a group of patients following forceful balloon dilatation for the treatment of achalasia of the cardia. Paired erect radionuclide esophageal transit studies and erect barium swallows of a group of patients who had undergone pneumatic balloon dilatation for the treatment of achalasia were analyzed. Indices derived from the radionuclide transit study were the percentage of maximum activity remaining in the esophagus 30 s after swallowing a dilute volume of tracer (A30 s) and the percentage of retained activity remaining at 100 s after washout with a bolus of water (A100 s). Indices derived from the barium swallow were a subjective grading of the degree of esophageal dilatation on a 4-point scale and a similar grading of the maximum distensibility of the gastroesophageal channel. Twenty five pairs of radionuclide and barium studies in 18 patients were analyzed. There was statistically significant correlation between the amount of retained activity on the radionuclide studies and degree of esophageal dilatation on the barium studies (r = 0.69 for A30 s, r = 0.56 for A100 s, P = < 0.01). There was no correlation between the amount of retained activity on the radionuclide studies and the degree of distension of the gastroesophageal channel on barium studies. The relationship between the radionuclide esophageal transit curve and barium appearances of the esophagus following pneumatic balloon dilatation for the treatment of achalasia is complex. The transit study provides unreliable information about the distensibility of the gastroesophageal channel and should not be relied upon in isolation for assessment of the efficacy of treatment.

Adolescent↗
PubMed1981

Swallowing dysfunction in acutely ill patients.

Swallowing problems are often unrecognized in acutely ill patients because of failure to consider abnormalities in the oropharyngeal phase of deglutition. Even the commonly used descriptive term dysphagia more often connotes food sticking in the esophagus rather than a disturbance in the physiologic separation of respiratory and digestive tracts during swallowing. To emphasize deglutitional abnormalities, we prefer the term swallowing dysfunction. In this review we describe the potentially fatal consequences of swallowing dysfunction, how dysfunction is recognized clinically, and the conditions in which it should be suspected. Certain aspects of airway and nutritional management are also described because supportive medical care and rehabilitative therapy in the acutely ill often go hand in hand. The methods of evaluation and rehabilitative treatment we describe are relatively simple and easily adapted by the busy staff in a general hospital or intensive care unit. Despite the simplicity of these methods, results are frequently gratifying and can be life saving in acutely ill patients.

Acute Disease↗
PubMed1999

Causes and complications associated with swallowing disorders in traumatic brain injury.

A major complication commonly seen in persons with severe brain injury is swallowing dysfunction. The neuropathology leading to impaired swallowing is discussed. In addition, Other risk factors associated with dysfunctional swallowing, such as tracheostomy and the need for prolonged ventilatory support, are discussed. Within the intensive care environment, the consequences of impaired swallowing leading to aspiration-a major cause of pneumonia-are discussed.

Brain Injuries↗
PubMed1998

Medullary swallowing-related neurons in the anesthetized cat.

Swallowing-related neurons (SRNs) were recorded systematically in the medulla oblongata of urethane-anesthetized cats. The SRNs received orthodromic inputs from the superior laryngeal nerve (SLN) and showed transient changes in their activity synchronous with swallowing. These neurons could be divided into three types. Type I SRNs are sensory-relay neurons from the SLN in the nucleus of the tractus solitarius (NTS), type II are interneurons located diffusely in the parvocellular reticular formation ventral to the NTS, which received oligosynaptic inputs from the SLN, and type III are motoneurons in the nucleus ambiguus. Some type II neurons still showed the swallowing activity after the animals were paralysed, which suggests that they could be involved in the generation of swallowing outputs.

Anesthetics↗
PubMed1990

Swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes.

Eleven patients were tested for swallowing dysfunction after prolonged orotracheal intubation. Ten had a tracheostomy tube. Mean duration of orotracheal intubation was 19.9 days, mean age 65 yr, and no patient had a concomitant neurologic deficit. All patients had a modified barium swallow with videofluoroscopy. All patients had at least one defect of 11 defects characterized. There was a mean of six defects/patient. The most common defects were delayed triggering of the swallow response (present in all patients) and pharyngeal pooling of contrast material (n = 9). Follow-up videofluoroscopy was performed in five patients (all had improved) with mean defects decreasing from 6.1 to 2.8/patient. With one exception, no patient had any defect that was worse than mild in severity. We concluded that prolonged orotracheal intubation with or without tracheostomy may cause prolonged and severe swallowing dysfunction. The deficits improve with time. The presence of a gag reflex does not confer protection against aspiration of pharyngeal contrast.

Aged↗
PubMed1998

The chewable barium tablet slow tracking of oral and pharyngeal swallowing dysfunction.

Dysphagia can be due to oral or pharyngeal dysfunction as well as to esophageal causes. Oral and pharyngeal disturbances, however, are more common in older people because of their attendant risks of laryngeal, tracheal, and pulmonary aspiration. To guide any dietary prescriptions it is important to establish whether the patient can best tolerate liquids, soft foods, solid chewable boluses, all, or none of these. It therefore becomes important to supplement liquid barium swallowing studies with soft and chewable boluses mixed with barium. Here I describe the novel introduction of chewable barium tablets in conjunction with routine swallowing studies. Chewable barium tablets, if used properly, are safe, supply needed information, and can shorten the evaluation of oral and pharyngeal dysfunction studies. Because of the granular appearance of the tablets, aspiration due to this solid chewable bolus can be distinguished from liquid aspiration. Moreover, if the barium tablets are swallowed whole, they can help delineate esophageal strictures if the oral and pharyngeal phases of swallowing are normal.

Administration, Oral↗
PubMed2002

Swallowing disorders in the elderly.

Changes that occur as a natural part of senescence in the complex action of deglutition predispose us to dysphagia and aspiration. As the "baby-boomers" begin to age, the onset of swallowing difficulties will begin to manifest in a greater number of our population. Recent advances in the evaluation of normal and abnormal swallowing make possible more precise anatomical and physiological diagnoses. Coupled with an understanding of swallowing physiology, such detailed evaluation allows greater opportunity to safely manage dysphagia with directed therapy and appropriate surgical intervention. The current study is a discussion of the changes that occur in deglutition with normal aging, contemporary evaluation of swallowing function, and some of the common causes of dysphagia in elderly patients.

Aged↗
PubMed2003

The safety of flexible endoscopic evaluation of swallowing with sensory testing in an outpatient otolaryngology setting.

OBJECTIVE: To study the safety of flexible endoscopic evaluation of swallowing with sensory testing in a private otolaryngology office setting. STUDY DESIGN: Five parameters were prospectively evaluated. These included airway compromise, epistaxis, change in heart rate, level of discomfort, and patient's willingness to repeat the examination in the future. METHODS: All persons undergoing flexible endoscopic evaluation of swallowing with sensory testing between July 1, 1999, and June 30, 2001, were prospectively evaluated. A flexible fiberoptic endoscope with a specially designed air port channel was passed transnasally (without topical anesthesia or nasal constriction) into the more patent nostril. Nasopharyngeal and laryngeal anatomy were first evaluated. Laryngopharyngeal sensory and motor function were then assessed, followed by a comprehensive swallowing evaluation. Five test parameters were examined during each study. Descriptive statistics were calculated. RESULTS: Three hundred forty-nine consecutive examinations in 305 adult patients with dysphagia were performed during the study period. Mild epistaxis occurred in four patients (1.1%). There were no episodes of airway obstruction or laryngospasm. There was no statistically significant difference between the average pretest and post-test heart rates; no patients became symptomatically bradycardic or tachycardic. The discomfort ratings were as follows: 44 patients (12.6%) rated the overall discomfort of the test as none, 169 (48.4%) thought it was mild, 110 (31.5%) described moderate discomfort, and 26 (7.5%) said it was severe. Three hundred forty-two (98%) of the patients would repeat the test in the future; seven patients (2%) said that they would not. CONCLUSIONS: Flexible endoscopic evaluation of swallowing with sensory testing is a safe, well-tolerated procedure to objectively evaluate patients with dysphagia when performed by an experienced speech-language pathologist with an otolaryngologist in attendance in an outpatient office setting.

Adult↗
PubMed1985

Oesophageal transit of liquid: effects of single or multiple swallows.

The effects of single and multiple swallowing on oesophageal transit have been evaluated in healthy subjects. It was shown that the transit patterns observed after multiple swallowing were different from that observed after a single swallow. It was concluded that for the detection of oesophageal transit abnormalities, the test should be performed using a single swallowed bolus.

Deglutition↗
PubMed1987

Reproducibility of oesophageal transit studies: several 'single swallows' must be performed.

The 'single swallow' technique for the isotopic investigation of oesophageal function has been widely accepted. In our experience the results obtained when several consecutive 'single swallow' tests are performed show considerable variation. Although one or two swallows may be enough to diagnose abnormality, the exclusion of a motility disorder requires more, preferably six consecutive swallows.

Adult↗
PubMed1997

Quantification of swallowed saliva in aspirated gastric juice.

OBJECTIVE: The aim of this study was to test a new mathematical model of the electrolyte concentrations in basal gastric secretion and to demonstrate whether this model was better than the old formula. Previous evidence suggests that primary gastric acid secretion has an electrolyte composition of [H+] 145, [Na+] 7, [K+] 17 and [Cl] 170 mmol/l, and that this can be modified by an extragastric component consisting of duodenogastric reflux and swallowed saliva. The only quantitative measurement available to date ignores the swallowed saliva. METHOD: Under basal conditions, gastric juice was aspirated and simultaneous sampling of saliva was performed in 60 adult subjects (33 men, 27 women), aged 23-85. Na+, K+, Cl-, phenol red (marker for pyloric loss) and titratable acidity or alkalinity were measured in aspirated gastric juice, and epidermal growth factor (EGF) was measured in saliva and gastric juice. Estimates of the primary gastric acid secretion were made by two methods: (1) V(G) formula which corrects for the duodenogastric reflux and assumes that there is no swallowed saliva: and (2) V(acid) formula, a novel procedure intended to correct for swallowed saliva as well and based on the known concentrations of electrolytes in saliva secreted at varying rates. RESULTS: The mean EGF concentrations were 3.42 ng/ml in saliva, 3.40 ng/ml in gastric juice. From the relationship of EGF output versus calculated primary acid secretion, the concentration of EGF in the extragastric component could be calculated. The V(G) formula gave a zero value of EGF whilst with V(acid), the calculated concentration of salivary EGF was 3.73 ng/ml and showed close correspondence with the measured EGF concentration in spat saliva. CONCLUSION: It is concluded that the new formula is more accurate, and gives a reasonable measurement for the volume of saliva in aspirated gastric juice.

Adult↗
PubMed2005

The influences of Halo-vest fixation and cervical hyperextension on swallowing in healthy volunteers.

STUDY DESIGN: Radiographic and electromyographic evaluation of swallowing functions was performed for different positions with a Halo-vest brace. OBJECTIVES: The aim of this study was to clarify the mechanism of dysphagia of cervical hyperextension with a Halo-vest brace in neurologically normal adult volunteers. SUMMARY OF BACKGROUND DATA: Garfin et al reported that 3 of 179 patients had dysphagia attributable to the Halo-vest brace after cervical spinal cord injury. Readjustment of the position of the head in the Halo-vest brace was required in those cases. They concluded that the head-extended position with a Halo-vest brace made it difficult to swallow. However, the details of this dysphagia were not known. METHODS: Six healthy adults volunteers between the ages of 24 and 33 participated in this study. Subjects were radiographically and electromyographically observed swallowing thin liquids at the neutral position without a Halo-vest brace (N-HV), the neutral position with a Halo-vest brace (N+HV) and at hyperextension with a Halo-vest brace (E+HV). RESULTS: In the durational measurements, there were significant changes between the N-HV and E+HV in pharyngeal transit time. The motion measurements showed that the initial hyoid position placed lower from the mandibular plane, and vertical hyoid movement was prolonged in the E+HV. In the electromyographic measurements, greater activity was observed from the suprahyoid muscles in the E+HV. One subject had laryngeal penetration already in the N-HV, and the same subject exhibited aspiration in the E+HV. Another two subjects exhibited penetration in the E+HV. CONCLUSION: The result of this study demonstrated that cervical hyperextension with the Halo-vest brace caused mechanical changes in the swallowing of normal healthy adult volunteers.

Adult↗