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PubMed1993

The effect of swallowing bolus and head position on eustachian tube function via sonotubometry.

Eustachian tube function was evaluated by sonotubometry in otologically normal young adults. The purpose of the research was to determine if the incidence or duration of eustachian tube opening would be altered with changes in swallowing bolus volume or changes in head rotation. The subject performed multiple swallows of 10 cc water bolus and dry swallows (saliva), with the head in the straight-forward, turned right, and turned left positions. Both ears were evaluated. The average incidence and duration of eustachian tube opening for all swallows was 74% (398 msec). No significant differences were found with any combination of bolus type or head position, suggesting that neither liquid bolus volume nor head rotation need be controlled when sonotubometry is performed.

Adult↗
PubMed2005

Comparison between swallowing and chewing of garlic on levels of serum lipids, cyclosporine, creatinine and lipid peroxidation in renal transplant recipients.

Hyperlipidemia and increased degree of oxidative stress are among the important risk factors for Atherosclerosis in renal transplant recipients (RTR). The Medical treatment of hyperlipidemia in RTR because of drugs side effects has been problematic, therefore alternative methods such as using of Garlic as an effective material in cholesterol lowering and inhibition of LDL Oxidation has been noted. For evaluation of garlic effect on RTR, 50 renal transplant patients with stable renal function were selected and divided into 2 groups. They took one clove of garlic (1 gr) by chewing or swallowing for two months, after one month wash-out period, they took garlic by the other route. Results indicated that although lipid profile, BUN, Cr, serum levels of cyclosporine and diastolic blood pressure did not change, Systolic blood pressure decreased from 138.2 to 132.8 mmHg (p=0.001) and Malondialdehyde (MDA) decreased from 2.4 to 1.7 nmol/ml (p=0.009) by swallowing route, Cholesterol decreased from 205.1 to 195.3 mg/dl (p=0.03), triglyceride decreased from 195.7 to 174.8 mg/dl (p=0.008), MDA decreased from 2.5 to 1.6 nmol/ml (p=0.001), systolic blood pressure decreased from 137.5 to 129.8 mmHg (p=0.001), diastolic blood pressure decreased from 84.6 to 77.6 mmHg (p=0.001) and Cr decreased from 1.51 to 1.44 mg/dl (p=0.03) by chewing route too. However HDL, LDL and cyclosporine serum levels had no significant differences by both of swallowing and chewing routes. We conclude that undamaged garlic (swallowed) had no lowering effect on lipid level of serum. But Crushed garlic (chewed) reduces cholesterol, triglyceride, MDA and blood pressure. Additionally creatinine reduced without notable decrease in cyclosporine serum levels may be due to cyclosporine nephrotoxicity ameliorating effect of garlic.

Adult↗
PubMed1991

Fetal rehydration via intraamniotic fluid: contribution of fetal swallowing.

Amniotic fluid volume is regulated by a balance of fetal fluid production and resorption. Although fetal swallowing is believed to be a major site of fluid resorption, additional routes of fluid exchange also may contribute. In our present study, five chronically prepared, water-restricted, pregnant ewes with singleton fetuses (128 +/- 1 d) were rehydrated via an intraamniotic infusion (100 mL/h over 90 min) of 0.075 M saline. In response to the maternal water restriction, significant increases were noted in maternal and fetal plasma osmolalities (306.6 +/- 1.2 to 315.4 +/- 2.4; 300.5 +/- 1.5 to 311.0 +/- 1.6 mosmol/kg, respectively) and arginine vasopressin concentrations (1.9 +/- 0.2 to 22.6 +/- 5.0; 1.5 +/- 0.1 to 8.5 +/- 2.2 pg/mL, respectively). After the intraamniotic infusion, fetal plasma osmolality (311.0 +/- 1.6 to 303.0 +/- 1.2 mosmol/kg) and hematocrit (36.7 +/- 1.9 to 33.8 +/- 1.4%) significantly decreased although there was no change in maternal arterial blood values. Fetal swallowing averaged 0.39 +/- 0.10 mL/min during the basal period and 0.34 +/- 0.17 mL/min at maximum dehydration, and decreased significantly to 0.19 +/- 0.07 mL/min in response to the intraamniotic infusion. These results indicate the rapid absorption of intraamniotic fluid by the dehydrated ovine fetus, despite the suppression of fetal swallowing. The volume swallowed during and after the intraamniotic infusion was insufficient to account for the observed changes in fetal plasma osmolality and hematocrit. Thus, alternative routes of fluid absorption (i.e. intramembranous flow) likely predominate under conditions of increased fetal plasma to amniotic fluid osmotic gradients.

Absorption↗
PubMed1990

Relearning to swallow after stroke--application of maneuvers and indirect biofeedback: a case study.

A patient with medullary infarct recovered swallowing at 45 months after stroke by using a series of pharyngeal swallow maneuvers. Each maneuver effected quantifiable changes in specific elements of the pharyngeal swallow. The success of these maneuvers is the basis for the conceptualization of the pharyngeal swallow as a cluster of closely coordinated neuromuscular actions which are independently modifiable, rather than a single event.

Biofeedback, Psychology↗
PubMed2000

The mechanics of swallowing and the muscular control of diverse behaviours in gopher snakes.

Snakes are excellent subjects for studying functional versatility and potential constraints because their movements are constrained to vertebral bending and twisting. In many snakes, swallowing is a kind of inside-out locomotion. During swallowing, vertebral bends push food from the jaws along a substantial length of the body to the stomach. In gopher snakes (Pituophis melanoleucus) and king snakes (Lampropeltis getula), swallowing often begins with lateral bending of the head and neck as the jaws advance unilaterally over the prey. Axial movement then shifts to accordion-like, concertina bending as the prey enters the oesophagus. Once the prey is completely engulfed, concertina bending shifts to undulatory bending that pushes the prey to the stomach. The shift from concertina to undulatory bending reflects a shift from pulling the prey into the throat (or advancing the mouth over the prey) to pushing it along the oesophagus towards the stomach. Undulatory kinematics and muscular activity patterns are similar in swallowing and undulatory locomotion. However, the distinct mechanical demands of internal versus external force exertion result in different duty factors of muscle activity. Feeding and locomotor movements are thus integral functions of the snake axial system.

Animals↗
PubMed1995

Technical note: dynamic analysis of the pharynx during swallowing using Turbo-FLASH magnetic resonance imaging combined with an oral positive contrast agent--a preliminary study.

Serial images of the swallowing motions of 10 healthy volunteers were taken using the Turbo-fast low angle shot (FLASH) magnetic resonance (MR) imaging sequence, while the subject swallowed an oral contrast agent containing ferric ammonium citrate. In all cases, the flow of the contrast agent and the motion of the organs in the oral cavity and the pharynx during swallowing could be observed. High-speed MR imaging combined with an oral positive contrast agent has the potential to evaluate accurately swallowing motion.

Adult↗
PubMed1994

Physiology of oral swallowing studied by ultrasonography.

The aim of the study was to identify a number of sonographic landmarks in the evaluation of the oral phase of swallowing. Forty non-dysphagic adults (average age 38 years) and 20 normal bottle-fed newborns (average age 13 days) were submitted to videorecorded sonographic examination using two types of transducers (5 and 7.5 MHz). The adults were asked to swallow a 20 ml bolus of water and the newborns were examined while sucking from a bottle containing milk. Preliminary transverse scans of the neck were obtained to evaluate laryngeal movements during swallowing. The mouth was examined through the submental window using sagittal and coronal scans. In the newborn, additional transbuccal scans were employed. In both adults and newborns highly significant and reproducible images of single-element motor events involved in swallowing were obtained. Normal sonographic images of the oral stage of deglutition form the baseline from which abnormal patterns may then be recognized.

Adult↗
PubMed2003

[Clinical, endoscopical and manometric evaluation of swallowing in patients with acquired autoimmune myasthenia gravis].

Dysphagia, or difficulty swallowing, is a common problem following myasthenia gravis (MG) and may lead to aspiration of saliva, food or liquids. We herein present 22 MG patients, with complaint of dysphagia, evaluated by phonoaudiological evaluation, nasofibrolaryngoscopical analysis and manometry of upper esophageal sphincter. The main objective was to evaluate the phases of the swallowing process and anatomical and functional aspects of oropharyngeal musculature. The age of patients varied from 19 to 74 years; being 19 female and 3 male. The main data were: (1) statistically significant relation between the phonoaudiological clinical evaluation and nasofibrolaryngoscopical one; (2) stomatognatical system disorders present in 100%; (3) swallowing and chewing disorders present in 100%, when clinically evaluated, and in 81,8% when evaluated by the nasofibrolaryngoscopy; (4) statistically significant relation between penetration/aspiration and antecedents of pneumonia; (5) stomatognatical muscles very altered, difficulty controlling the bolus, collection of food in the pharynx or larynx and presence of penetration and/or aspiration showed significant correlation with weakness of a pharyngeal muscles. These findings justify the necessity to evaluate clinically the swallowing phases in MG patients, with the main purpose to prevent both aspiration and dehidration from inadequate oral intake.

Adult↗
PubMed2002

Mosquito abundance is correlated with cliff swallow (Petrochelidon pyrrhonota) colony size.

We measured the abundance of mosquitoes [primarily Aedes vexans (Meigen) and Culex tarsalis Coquillett] at cliff swallow (Petrochelidon pyrrhonota Vieillot) colonies of different sizes in southwestern Nebraska in 1999. Using CO2 traps placed inside and outside of colonies, we found that total mosquito abundance increased significantly with the number of active cliff swallow nests at a colony site. We found no effect of date or weather conditions on the number of mosquitoes caught it the different sites. By classifying the landscape from aerial photographs within a 2-km-diameter circle centered on each colony site, we found no significant relationships between habitat type near a colony site and cliff swallow colony size or mosquito abundance. Proximity to livestock could not account for our results. Culex tarsalis was proportionately more likely to be caught inside a colony than at traps 30 in away, but the proportion of C. tarsalis inside a colony did not vary with colony size. Our results cannot be explained by date- or weather-related sampling artifacts or by differences in habitat between sites. Most likely, mosquitoes, especially A. vexans, are attracted to the vicinity of large cliff swallow colonies.

Aedes↗
PubMedDate not supplied

Dysphagia in stroke: Development of a standard method to examine swallowing recovery.

This study began development of a standard method that uses the videofluoroscopic swallow study for evaluation of swallowing recovery after stroke based on a definition of dysphagia derived from three domains: bolus timing, bolus direction, and bolus clearance. Two experiments were conducted: one that defined normal versus disordered swallowing based on the range of scores in a sample of healthy adults (n = 13), and one that applied these thresholds to nine stroke patients to identify the presence of dysphagia. Results indicate that acute and protracted dysphagia may be more accurately detected by identifying abnormalities on multiple objective measures of swallowing rather than on laryngeal penetration or aspiration alone. Results indicate that our selected measures and use of healthy control subjects to establish normal thresholds may eventually contribute to the definition and differentiation of dysphagic and nondysphagic patients. Further research with a broader sample of healthy controls and stroke patients is mandatory.

Aged↗
PubMed1989

[Human mandibular movements during swallowing saliva. 1. Tooth contacts and rest position].

We investigated the swallowing of saliva on 11 adults with a normal tooth alignment and a normal occlusion. The envelope of sagittal incisal point movements of the mandible was analyzed by means of the infrared sensor system. Frankfurt horizontal plane was used as a reference plane. The following conclusions were obtained based on the experimental results. 1. The mean linear distance between retruded tooth contact position (RCP) and intercuspal position (ICP) was 1.35 mm. 2. The mean linear distance between most retruded tooth contact position during swallowing saliva (SRCP) and ICP was 0.13 mm. The ratio of SRCP to RCP was about 10 percent. 3. The rest position of the mandible induced by swallowing saliva (RP) was 1.05 mm apart from ICP. 4. The maximum interocclusal distance during a cycle of swallowing saliva (MOP) was 1.70 mm in the average of 11 subjects. RP and MOP were significantly different from each other in the average of 11 subjects. However, individuals whose RP and MOP were significantly different were 6 subjects of 11.

Adult↗
PubMed2006

[Evaluation of prosthetic treatment using number of chewing strokes until swallowing of water absorbing rice crackers].

PURPOSE: Various methods of evaluating the ability of mastication have been reported, most of which involve evaluating of the ability to comminute foods. In this study, a new method of evaluating the ability of mastication focusing on bolus formation was applied to denture wearers. METHODS: One hundred and twenty-five subjects (71 males and 54 females) using removable dentures and receiving follow-up in the Niigata University Hospital were selected. This group was categorized by Eichner's classification, and investigated for the effect of prosthetic treatment by counting the number of chewing strokes until the first swallow of rice crackers. RESULTS: It was clarified that the number of chewing strokes until the first swallow counted by visual observation agreed well with the number of chewing strokes counted by electromyogram wave of masseter muscle, laryngeal motion, and swallowing sound, as a preparatory experiment. Using the method of counting chewing strokes by visual observation, the effect of prosthetic treatment was evaluated, and the results were as follows. 1)There is a significant difference in the number of chewing strokes without dentures between the Eichner A group, B group, and C group. 2)There was no significant difference in the number of chewing strokes with dentures among the three groups. 3)A significant decrease in the number of chewing strokes was proven by the use of removable dentures. 4)Both the improvement rate of chewing strokes (the ratio of the number of chewing strokes with dentures until the first swallow to that without dentures) and the difference of chewing strokes increased significantly in the order of Eichner A, B, and C. CONCLUSION: It was clarified that the effect of prosthetic treatment can be quantitatively evaluated by counting the chewing strokes of rice cracker. Moreover, it was suggested that the condition of prosthetic treatment can be evaluated by analyzing the improvement rate of chewing strokes.

Aged↗
PubMed1997

Timed barium swallow: a simple technique for evaluating esophageal emptying in patients with achalasia.

OBJECTIVE: Our purpose was to define a simple technique for timing a barium swallow by which radiologists can assess esophageal emptying in patients with achalasia before and after minimally invasive therapy. Our purpose was also to determine the best method of quantifying the degree of emptying using this timed technique. MATERIALS AND METHODS: In the barium swallow technique, upright frontal spot films of the esophagus are obtained at 1, 2, and 5 min after ingestion of 100-200 ml of low-density (45% weight in volume) barium sulfate (volume of barium determined by patient tolerance). Forty-two of these barium swallows done by 23 patients with achalasia were retrospectively reviewed. The examination served either as a baseline study or as a 1-month follow-up study after patients had undergone pneumatic dilatation or Clostridium botulinum toxin injection. The spot films were digitized, and a region of interest was drawn around the column of barium by two observers. The change in area seen in the region of interest on the 1- and 5-min films served as the gold standard for percentage of emptying. The spot films were then analyzed by four other observers, each of whom independently, subjectively, and qualitatively estimated the percentage of emptying between the 1- and 5-min spot films. Percentages were divided into quintiles. On a separate occasion, each of these four observers also independently measured the height and width of the barium column on the 1- and 5-min spot films. The product of height times width seen on the 1- and 5-min films became the quantitative estimate for percentage of emptying. RESULTS: We found no statistically significant difference between the percentage of emptying as measured on the digitized images by the two observers and the height-times-width calculations or qualitative emptying percentage as estimated by the four observers. Interobserver agreement for the area evaluated on the digitized films as well as the height-times-width measurements and qualitative estimates of emptying was almost perfect (the correlation coefficients being 0.99, 0.87, and 0.93, respectively). CONCLUSION: The timed barium swallow is a simple and reproducible technique. Both qualitative assessment and estimated change in area based on height-times-width measurements of the barium column are accurate methods of estimating esophageal emptying.

Adolescent↗
PubMed2006

Prospective randomized trial comparing the effect of early suturing of tracheostomy sites on postoperative patient swallowing and rehabilitation.

PURPOSE: This study was designed to evaluate the effect of tracheostomy site suturing after decannulation on swallowing rehabilitation, the incidence of postoperative complications, the length of hospital stay, and overall cost saving in patients undergoing major head and neck cancer resections. DESIGN: Prospective, randomized, blinded, controlled clinical trial. METHODS: Seventy-five patients undergoing major head and neck cancer resections were block randomized to have their tracheostomy site sutured or not sutured at the time of decannulation. Two blinded speech-language pathologists conducted bedside swallowing assessments immediately after decannulation. Patients resumed oral feedings if they passed; otherwise, the assessment was repeated daily until they were able to resume oral feedings or required a G-tube. OUTCOME MEASURES: We monitored (1) time intervals during the admission from surgery to discharge, (2) the rate of aspiration, (3) complications, and (4) cost savings. RESULTS: Significant differences were seen in the mean time from decannulation and commencement of swallowing (suture arm, 0.58 days; nonsuture arm, 2.7 days; p = .013). There was also a significant difference seen for the time interval from decannulation to discharge from hospital (suture arm, 5.5 days; nonsuture arm, 8.3 days; p = .045) and for overall duration of hospital stay (suture arm, 14.6 days; nonsuture arm, 19.3 days; p = .025). The cost saving per patient in the suture group averaged $11 609, which translates to a yearly saving of 742 976 dollars. CONCLUSION: The suturing of the tracheostomy site in head and neck cancer patients after decannulation is a safe, effective, cost-saving manoeuvre that speeds the return of the patient's normal swallowing, promoting earlier discharge from the hospital.

Adult↗
PubMed1977

Composition of the alkaline component of human gastric juice: effect of swallowed saliva and duodeno-gastric reflux.

Five patients (four with vitiligo and one with pernicious anaemia) were subjected to the histamine infusion test; there were achlorhydric while the remaining two secreted quite small amounts of acid. [Na+],[Cl-)and[alkali]were determined in the alkaline gastric juice samples (pH greater than 7.0). In order to assess the contribution of swallowed saliva the histamine test was done twice in each patient: (A) with precautions to prevent swallowing of saliva; and (B) with the patient allowed to swallow saliva freely. In each sample reflux of duodenal juice was estimated so that its contribution to the alkaline gastric aspirate could be assessed. Such reflex was absent in one patient, negligible in another, while in the remaining three patients the mean pyloric reflux amounted to no more than 8% of the observed volume. Swallowed saliva had diluting effect on [Na+] and [Cl-] but raised K+ concentration in the alkaline gastric aspirate. The comparison of alkaline gastric juice, free to an appreciable extent of salivary contamination, was shown to be relatively constant. The results are consistent with the two-component hypothesis of gastric secretion.

Adult↗
PubMed2001

[Findings of bedside swallowing assessment and brain computerized tomography in patients with chronic cerebral infarction, and their outcome].

To estimate the usefulness of the bedside swallowing assessment proposed by Smithard et al and neuroimaging findings characteristic for dysphagia, we studied the outcome of 102 patients with chronic cerebral infarction after assessment of swallowing by this test with brain computerized tomography (CT). All patients had a variety of motor disturbance and were admitted on a long-term medicare basis. They were divided into two groups according to the findings: the positive group (n = 33), who showed any of the listed types of difficulty in swallowing water, and the negative group (n = 69). Followed up to 2.2 years, their outcomes were studied. CT findings were studied on type of infarction, number and laterality of infarction, grade of periventricular lucency (PVL), presence of ventricular dilatation (VD), and severity of cortical atrophy (CA). The mean age was 76.4 years at registration and 61 were men. The frequency of severe dementia and disturbed ADL were significantly higher in the positive group. Eighteen patients died during the observation period and 15 of those were in the positive group, indicating higher annual death rate (29.9% vs 2.2% in the negative group). All of the 15 patients in the positive group died of pneumonia. CT findings showed high incidence of multiple infarction, bilateral hemispheric lesion, severe PVL, VD, and severe CA in the positive group. These findings indicated that this evaluation method was useful in screening swallow function for patients with cerebral infarction in the chronic phase. Furthermore, CT findings suggested that severe white matter lesion, VD, and severe CA as well as multiple infarction seen in bilateral hemisphere was related to dysphagia, probably due to multiple factors involving pyramidal- and extrapyramidal-tracts with higher brain function.

Adult↗
PubMed1993

[Disorder of swallowing muscles in iron deficient rabbits].

Plummer-Vinson syndrome is a clinical entity associated with dysphagia, sideropenic anemia and atrophic glossitis. Using rabbits with iron deficiency anemia, the author investigated the cause of dysphagia in this syndrome. Iron deficient animals were produced by bolus feeding without iron and intramuscular injection of an iron-chelating agent. The fibers of swallowing muscles (the thyro-pharyngeal, cricopharyngeal and cervicoesophageal muscles) were classified into three types (Type 1, 2A and 2B fibers) by actomyosin ATPase staining. No significant difference between the muscles of sideropenic rabbits and those of normal rabbits were found in the composition and distribution of their muscle fibers. By NADH-TR staining, however, the disturbance of the intermyofibrillar network and/or a "Moth Eaton" appearance, known to be caused by leakage of mitochondria, were observed in Type 1 fibers of the swallowing muscles of sideropenic rabbits. These morphological changes are similar to those observed in progressive muscular dystrophy. The quantity of iron in the swallowing muscles of sideropenic rabbits was significantly reduced in comparison with that in the sternothyroid and femoral muscles. This finding suggests that a selective decrease in myoglobin occurs in the swallowing muscles of iron deficient animals. From these observations, it might be concluded that dysphagia in iron deficiency anemia is caused by a myogenic disorder.

Anemia, Hypochromic↗
PubMed1990

Clinical assessment and management of swallowing difficulties after stroke.

The purpose of this study was to investigate the frequency of swallowing disorders in patients with stroke referred for speech pathology, and to determine the outcome of therapeutic intervention based on presenting symptoms ascertained from clinical bedside assessment. The study was conducted over a 12-month period (1988) in a 191-bed acute-care hospital. Data on referral of patients with stroke to the Speech Pathology Department and frequency of swallowing disorders were analysed, and showed a referral rate of 61% for patients with stroke, with a 54% prevalence of swallowing disorders among referred patients. On discharge, 75.5% of patients who had exhibited swallowing disorders were on full oral diets.

Cerebrovascular Disorders↗