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PubMed1978

Relationship between tubal function, craniofacial morphology and disorder of deglutition.

26 children without hearing impairment have been examined by otolaryngologists and orthodontists. According to the tubal function test in a pressure chamber they were classifed into a group with good and poor tubal function. The E.N.T. examination was unconclusive for a possible relationship between rhinological findings, mode of breathing, sinusitis, size of tonsils, nasal airway resistance and tubal function. Adenoids proved to be a mechanical impairment for active tubal function as stated by many authors. The cephalometric analysis of lateral head films combined with a static and dynamic-functional evaluation of tongue posture revealed significant differences between children with good and poor tubal function. Subjects with a vertical craniofacial growth pattern seem to be predisposed for poor tubal function. Analysing static tongue posture in children with poor tubal function the tongue lies more retracted in a backward position. The back of the tongue is flattened in relation to the palatal arch. In children with good tubal function there is a much closer contact between the back of tongue and the hard palate. Subjects with poor tubal function have an increased incidence of abnormal deglutition combined with tongue-thrust, teeth-apart swallowing, lack of sealing off the anterior oral cavity and contraction of the circumoral musculature. In children with good tubal function one can find the somatic type of swallowing that means no contractions of the circumoral muscles, no tongue-thrust during deglutition but contact of the molars and contraction of the masseter muscle.

Airway Resistance↗
PubMed2002

Effects of atropine on the central mechanism of deglutition in anesthetized sheep.

The role of acetylcholine in the central mechanism of swallowing remains a matter of debate. The aim of this work, conducted in sheep, was to assess the effects of anti-muscarinic drugs (mainly atropine) on the activity of peripheral muscles involved in the oropharyngeal and esophageal phases of swallowing, and on that of dorsal medulla interneurons which program swallow-induced esophageal contractions and therefore belong to the so-called central pattern generator. Our results were obtained in anesthetized animals by means of electromyographic and manometric recordings of peripheral muscle contractions associated with microelectrode recordings of medullary interneuron discharge. They show that both interneuron discharge and primary esophageal contractions that follow the oropharyngeal component of swallowing were suppressed under atropine (0.1--0.5 mg/kg). In contrast, atropine did not impede the swallowing oropharyngeal component, the secondary peristalsis and the "deglutitive inhibition," which affects the esophageal motility during the oropharyngeal phase of swallowing. In conclusion, muscarinic receptors (probably not those of M(1)type) appear to control the primary peristalsis, but neither the secondary peristalsis nor the deglutitive inhibition.

Anesthetics, Inhalation↗
PubMed2004

Evaluation of normal deglutition with the help of rectified surface electromyography records.

Surface electromyographic (sEMG) studies were performed on 300 normal adults to estimate normal values of sEMG records of muscle activity in the detection and evaluation of stages of normal swallowing. Our study was a prospective observational study of healthy volunteers. The parameters evaluated during swallowing include the timing, amplitude (voltage), and graphic patterns of activity of the orbicularis oris, masseter, submental, and laryngeal strap muscles covered by the platysma. Three tests were examined: voluntary single swallows of saliva ("dry" swallow), voluntary single water swallows ("normal"), and voluntary single swallows of excessive amounts of water (20 ml, "stress test"). Duration and amplitude of muscle activity in oral, pharyngeal, and initial esophageal stages of swallowing (mean + standard deviation, range + standard deviation) were measured for groups of adults of different ages (18-40, 41-70, 70+ years). Shapes of graphic records were evaluated relative to timing and voltage. The overall normal mean values for stage-by-stage duration of muscle activity during single swallowing were established for healthy adults. The duration of muscle activity in all tests showed insignificant increases with age except for the elderly group (70+) in which it was statistically significant (SPSS, chi2 criterion, 95% confidence interval, p < 0.05). There were no statistically significant gender-related differences in duration or amplitude of muscle activity during single swallowing for any age group (p > or = 0.05). We conclude that the rectified and filtered sEMG provides a noninvasive means to assess certain aspects of complex muscle activity in deglutition. Surface EMG of swallowing is a simple and reliable noninvasive screening method for evaluating swallowing with low levels of discomfort. Stage-by-stage evaluation of duration can be very important for diagnosing the etiology of dysphagia. The combined normative timing of events, amplitude, and graphic data can be used for evaluating complaints and symptoms, as well as for comparison purposes in pre- and postoperative stages and in EMG monitoring during otolaryngological or neurological treatment. These parameters represent stages required for normal deglutition and provide a basis for the comparison of swallowing performance both within and between patients.

Action Potentials↗
PubMed2004

Cervical spinal cord injury and deglutition disorders.

The association of cervical spinal cord injury and swallowing disorders is clinically well recognized. This study was performed to determine the clinical significance and the outcome of deglutition disorders observed in the initial treatment of cervical spinal cord injury in our tertiary care spinal cord injury unit. All patients with cervical spinal cord injury admitted to our facility for initial care between January 1997 and December 2000 were included in our study. Prevalence of dysphagia and frequency of pneumonia were determined. An assessment of deglutition at discharge was performed. Dysphagia was diagnosed in 26 of the 73 patients with cervical spinal cord injury. Tracheostomy and duration of orotracheal intubation are associated with dysphagia. The disorder necessitated dietary restrictions in 18 patients. Six of these patients had to be discharged with a percutaneous enterogastric feeding tube; seven had persistent problems not resulting in dietary restrictions. The incidence of late pneumonia was significantly increased with two associated deaths. Dysphagia is a serious complication associated with prolonged requirement for ventilatory support. Patients have to be monitored closely because the incidence of pneumonia is increased. While the situation improves for most patients, a significant number of patients need a percutaneous enterogastric feeding tube as a permanent solution.

Adolescent↗
PubMed1990

Coordination of deglutitive glottic closure with oropharyngeal swallowing.

The goals of this study were to quantify the temporal relationship between swallow-induced glottic closure and (a) signals of swallow initiation, such as hyoid bone movement, tongue base movement, and mylohyoid electrical activity; (b) pharyngeal peristalsis; (c) laryngeal elevation; (d) vestibular closure; and (e) oropharyngeal barium bolus transit. Eight normal subjects (age 20-30 yr) were studied by concurrent transnasal video laryngoscopy, pharyngeal intraluminal manometry, and submental surface electromyography. The manometric, electromyographic, and both video recordings were synchronized with one another using a specially designed event marker. Dry, 5-ml water, and 5-ml barium swallows were recorded. Frame-by-frame analysis of the video endoscopic recordings showed that deglutitive laryngeal kinetics consisted of vocal cord adduction associated with transverse approximation of the arytenoids followed by vertical approximation of arytenoids to the base of the epiglottis followed by laryngeal ascent and epiglottic descent. Onset of swallow-induced vocal cord adduction preceded the onset of hyoid bone movement, base of the tongue movement, and submental surface myoelectric activity by 0.33 +/- 0.04 (SE) s, 0.31 +/- 0.04 s, and 0.38 +/- 0.04 s, respectively. Onset of vocal cord adduction also preceded the initiation of peristalsis in the nasopharynx and its propagation to oropharynx and upper esophageal sphincter by 0.64 +/- 0.05 s, 0.82 +/- 0.05 s, and 1.08 +/- 0.04 s, respectively. The time between the onset of vocal cord adduction and their return to full opening was 2.2 +/- 0.09 s. It was concluded that (a) among events evaluated, vocal cord adduction is the initial event during the swallowing sequence; (b) laryngeal kinetics during deglutition have distinctive features, and their close coordination with other swallowing events suggests that they are an essential feature of the swallowing program; and (c) abnormal laryngeal kinetics or lack of coordination between the glottic closure mechanism and oropharyngeal bolus transport may have an important role in swallow-induced aspiration.

Adult↗
PubMed1993

Deglutitive tongue action: volume accommodation and bolus propulsion.

BACKGROUND: Swallow function is best analyzed in components because discrete component failure may be compensated for with devised maneuvers, postures, or biofeedback techniques. The present investigation examined normal deglutitive tongue function. METHODS: Biplane videofluoroscopy synchronized with intraluminal manometry was performed in eight volunteers. Tongue surface motion was characterized as centripetal or centrifugal along seven equiangular rays emanating from the tongue center during 1-, 5-, 10-, and 20-mL swallows. RESULTS: The tongue perimeter remained in contact with the alveolar ridge while the central groove exhibited centripetal and subsequent centrifugal motion that, in conjunction with the pharyngeal walls, created an oropharyngeal propulsive chamber and then expelled that chamber's contents into the hypopharynx. Intrabolus propulsive pressure was generated when the initially expansive propulsive chamber volume contracted to the test bolus volume. Because pharyngeal chamber action cycle timing was relatively constant among bolus volumes, vigorous expulsion occurred with large volumes but relatively delayed, sluggish expulsion occurred with smaller volumes. CONCLUSIONS: Deglutitive tongue functions include bolus containment, volume accommodation, and the major contributor to bolus propulsion.

Adult↗
PubMed1995

Deglutitive tongue force modulation by volition, volume, and viscosity in humans.

BACKGROUND/AIMS: Deglutitive tongue biomechanics are complex, involving bolus containment, loading, and propulsion. This study aimed to quantify the modulation of deglutitive pulsive and clearing tongue forces in varied swallowing conditions. METHODS: Oropharyngeal pressure and force were recorded using sensing bulbs and strain-gauge manometry in 8 volunteers during swallows of varied volume and viscosity. Volitional modulation was explored with forceful and attenuated swallows. RESULTS: Temporal analysis confirmed that bulb recordings corresponded to tongue pulsive force, and the strain-gauge recordings measured tongue clearing pressure. Volition was the most potent modifier of both tongue pulsive force and clearing pressure with values showing a fourfold increase from attenuated to forceful swallows. Bolus viscosity also induced an increase of tongue pulsive force and clearing pressure by the oral tongue. Volitional control as well as adaptation to viscosity was greatest on the anterior and middle part of the oral tongue. There was no force adaptation with increased bolus volume. CONCLUSIONS: Tongue pulsive force and clearing pressure during swallow showed substantial modulation for bolus viscosity that can be reproduced by volitional control. The anterior two thirds of the tongue showed both greater forces and greater modulation than did the tongue base.

Adaptation, Physiological↗
PubMed1978

Fetal deglutition: a study of the anencephalic fetus.

The deglutition of amniotic fluid in utero by the anencephalic fetus is a controversial subject. We have studied 7 anencephalic pregnancies complicated by hydramnion in their third trimester of gestation. Fetographies revealed that 6 out of 7 anencephalic monsters showed signs of swallowing of the contrast material after only 3 h. The baby which was born dead could not swallow at all. The fact that the babies studied swallowed amniotic fluid shortly after injection of contrast media seems to confirm the opinion that fetal deglutition contributes only little to the mechanism of amniotic fluid volume regulation.

Adult↗
PubMed1989

Excitatory amino acid receptor-mediated activation of solitarial deglutitive loci.

The deglutitive actions of glutamate were investigated in urethane-anaesthetised rats in order to determine whether different excitatory amino acid receptors mediate activation of pattern generator elements contained within the nucleus tractus solitarii. When applied by micropneumophoresis (0.01-10 pmol) from multibarrelled glass micropipettes (tip diameter 2-5 microns), the excitatory amino acid-receptor agonists, N-methyl-D, L-aspartate (NMA), N-methyl-D-aspartate (NMDA), quisqualate and kainate displayed a rank order of potency at glutamate-responsive pharyngeal sites, in the subnuclei ventralis and intermedialis, where KA greater than NMA/NMDA greater than QA; however, the potency followed the order NMA/NMDA greater than KA greater than QA at oesophageal sites within the subnucleus centralis. The NMDA-receptor blockers, 2-amino-5-phosphonovaleric acid (APV) and 2-amino-7-phosphonoheptanoic acid (AP7), selectively and reversibly inhibited the glutamate-evoked oesophageal responses, but had no corresponding effect on rhythmic oesophageal responses elicited by muscarine. At loci in the nucleus tractus solitarius, where glutamate elicited a complete swallowing sequence, APV/AP7 spared the pharyngeal component but selectively blocked the oesophageal component. The nonselective glutamate-receptor antagonist, gamma-D-glutamylglycine suppressed both pharyngeal and oesophageal responses elicited by glutamate. It is concluded that different types of excitatory amino acid receptors are associated with the deglutitive premotor subnuclei of the nucleus tractus solitarii; kainate receptors predominate within the subnuclei ventralis and intermedialis and NMDA receptors within the subnucleus centralis. Both kainate- and NMDA-mediated mechanisms can operate under physiological conditions.

2-Amino-5-phosphonovalerate↗
PubMed2005

Premature closure of the upper esophageal sphincter as a cause of severe deglutition disorder in infancy.

Deglutition disorders in infancy are often associated with birth asphyxia or structural abnormalities in the hypopharynx, the trachea, or the esophagus. Manometry can be crucial for clarifying the dynamics of the swallowing disorder in the infant with deglutition problems and without signs of these causes. An 8-week-old infant was referred because of suspicion of cricopharyngeal achalasia causing persistent swallowing problems and failure to thrive. Manometry results showed normal resting tone and relaxation but premature closure of the upper esophageal sphincter. The infant was treated with balloon dilatation of the upper esophageal sphincter and expectance. A maturation process of the swallowing sequence was noted over time and documented by repeated manometric procedures.

Catheterization↗
PubMed2003

Voice and deglutition functions after the supracricoid and total laryngectomy procedures for advanced stage laryngeal carcinoma.

OBJECTIVES: This investigation compared speech and deglutition functions after alternative surgical treatments for advanced stage laryngeal carcinoma: the supracricoid laryngectomy (SCL) versus the total laryngectomy (TL). Study design and setting Cohort investigation at Wayne State University School of Medicine. METHODS: Quantitative studies of laryngeal biomechanics, acoustic and speech aerodynamic features, and deglutition skills of these individuals were coupled to listener and patient self-impressions of speech and voice characteristics for group comparative analyses. RESULTS: Results revealed that patients from each subgroup performed comparably relative to speech intelligibility and voice quality disturbances. Videostroboscopy of the neoglottal mechanisms in these two populations helped to explain these outcomes. Acoustic and speech aerodynamic testing demonstrated variably abnormal features in both surgical subgroups. Whereas the SCL patients eventually achieved full oral diets, they required many sessions of swallowing therapy to obtain this objective and eliminate tube feeding supplementation. The TL patients did not evidence protracted swallowing difficulties or the need for specific exercises in order to remove their feeding tubes postoperatively. References to organ preservation strategies in lieu of surgical management are included for completeness purposes. CONCLUSIONS: The SCL and TL surgical procedures for advanced stage laryngeal carcinoma resulted in equivalent speech and swallowing functional outcomes.

Biomechanical Phenomena↗
PubMed2006

Initial effects of the tongue crib on tongue movements during deglutition: a Cine-Magnetic resonance imaging study.

The objective of this study was to investigate the initial effects of a tongue crib on tongue movements during deglutition by using real time balanced turbo field echo (B-TFE) Cine-MR imaging. A total of 21 patients were evaluated in this study. The open-bite group (OBG) consisted of 11 patients (seven girls, four boys) who had a mean age of 11.09 +/- 2.02 years and a mean overbite of -5.14 +/- 1.83 mm. These patients were evaluated initially (T1) and while wearing a tongue crib (T2). A total of 10 patients (five girls, five boys) with a mean age of 14.5 +/- 2.6 years and with a mean overbite of 1.6 +/- 0.5 mm served as controls (CG), and only initial records were obtained from these patients. T2 was compared with T1 and CG. T1 was also compared with CG. We evaluated deglutition during three stages matching oral (1), pharyngeal (2), and esophageal (3) stages. Our results indicated that the tongue's tip positioned more posteriorly when the crib was in place (T2) compared with both T1 and CG; the anterior portion of the tongue's dorsum was at a lower position in T2 compared with both T1 and CG at stage 3; the midportion of the tongue's dorsum was at a lower position in T2 than in T1 and CG at stages 1 and 2. To compensate for the posterior position of the tongue's tip (caused by the tongue crib), adaptive changes occurred in the anterior and midportions of the dorsum of the tongue.

Adaptation, Physiological↗
PubMed2003

Tongue pressure on loop of transpalatal arch during deglutition.

The purpose of this study was to measure tongue pressure exerted on the loop of the transpalatal arch (TPA) during deglutition and to consider the influence of the distance of the loop of the TPA from the palatal mucosa and the anteroposterior position of the loop. Tongue pressures of 4 subjects with normal occlusion were measured with subminiature pressure sensors fixed on the TPA. The distances from the palatal mucosa to the surface of the pressure sensor were set at 2, 4, and 6 mm. The loop of the TPA was placed at the level of the middle of the maxillary second premolars (P), first molars (M1), or second molars (M2). Nine types of TPA devices were measured for each subject. The maximum recorded tongue pressure was taken from each act of deglutition. The minimum pressure value was exerted at position P when the distance from the palatal mucosa to the surface of the pressure sensor was 2 mm. The maximum value was obtained at position M2 and a distance of 6 mm from the palatal mucosa. When distances of 2, 4, and 6 mm were compared, significant differences between 2 and 4 mm, and between 2 and 6 mm were found. Significant differences were observed in comparisons between the positions P and M1, M1 and M2, and P and M2.

Adult↗
PubMed2006

Real time balanced turbo field echo Cine-MRI in the analysis of deglutition events and transit times.

Investigation of swallowing is an important part of oral diagnosis. It usually plays a role in the aetiology of some orofacial deformities and open-bite as well as in the relapse of treated open-bite patients. In recent years, the movements of the anatomical structures that participate in deglutition have been investigated by several methods such as cineradiography, electromyography, electropalatography, electromagnetic articulography and ultrasonography. However, all these techniques have various disadvantages. Recently, dynamic magnetic resonance imaging has become available in the evaluation of swallowing function. In this study we intended to present this new technique to the dental literature and aimed to obtain dynamic images of the deglutition process. We also compared the timing of events in subjects with anterior open-bite and normal overbite during swallowing 10 mL water.

Adolescent↗
PubMed1979

Endoscopic observations on the deglutition reflex in the horse.

Cine-endoscopy was used to study the deglutition reflex in 2 apparently normal horses. Closure of the nasopharyngeal sphincter was brought about by a lowering of the pharyngeal roof and an elevation of the soft palate caudal to the pharyngeal ostia of the auditory tubes. The medial cartilages of the ostia were not directly involved in bringing about closure of the sphincter. It is postulated that the opening of the ostia of the auditory tubes is brought about during deglutition by the combined action of the palatopharyngeus, pterygopharyngeus and tensor veli palatini muscles.

Animals↗
PubMed1993

Bursts of non-deglutitive simultaneous contractions may be a normal oesophageal motility pattern.

The frequency and characteristics of non-deglutitive motor activity of the human oesophagus and its relation to motility patterns in the antrum and upper small intestine were studied in 25 fasted healthy subjects. Motility of the oesophagus, antrum, and upper small intestine was recorded by means of a manometric perfused catheter system. The most striking non-deglutitive motility pattern consisted of repetitive bursts of non-sequential pressure peaks occurring in the smooth muscle portion of the oesophagus. The mean number of pressure peaks per burst was 2.7 (SD 2) waves with a mean amplitude of 19.5 (SD 9.9) mm Hg and a duration of 3.09 (SD 0.22) seconds. The highest amplitude was 80 mm Hg and the longest burst consisted of 13 repetitive waves. The bursts were recorded up to a distance of 15-20 cm above the lower oesophageal sphincter. Ninety five per cent of the bursts occurred during a 15 minute period before the onset of phase 3 of the migrating motor complex in the antral or upper small intestinal area, or during the lower oesophageal sphincter component of the migrating motor complex. In conclusion, spontaneous bursts of non-sequential pressure peaks occurred in the smooth muscle part of the human oesophagus in relation to phase 3 of the migrating motor complex. They represent the oesophageal body component of phase 3 of the migrating motor complex and are not a sign of oesophageal motor abnormalities.

Adult↗
PubMedDate not supplied

Deglutition after conservation surgery for cancer of the larynx and hypopharynx.

Conservation surgery for cancer of the larynx results in deglutition problems. Rehabilitation of swallowing function can successfully be managed by a team including a surgeon, a dietitian, and a nurse. This report details surgical reconstruction to prevent or treat aspiration, postsurgical dietetic management, and the nursing approach to deglutition training in a group of patients.

Deglutition Disorders↗
PubMedDate not supplied

Movement of the upper esophageal sphincter and a manometric device during deglutition. A cineradiographic investigation.

A cineradiographic examination of 9 healthy subjects showed asynchronous movement of a manometric device in relation to movement of the upper esophageal sphincter (UES) during deglutition. A single sensor placed within the UES high pressure zone at rest registered pressures existing outside this zone during the major part of deglutition. The manometric device must therefore comprise at least three sensors placed at different levels and about 10 mm apart if consistent pressure recording within this zone is to be achieved. In order to evaluate the pressure profile within the sphincter adequately, cineradiographic determination of the orientation of the measuring device is necessary. This was made possible by insertion of two mutually perpendicular radiopaque indicators into the catheter.

Adult↗