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PubMed1993

[Deglutition disorders in Lyme disease with severe neurological involvement].

A 67-year old man consulted for dysphagia to solid food and weight loss. Four years earlier he had developed Lyme disease with severe neurological involvement. Magnetic resonance imaging showed, on T2-weighted sequences, multifocal high-intensity signals located in the periventricular white matter and the brain stem. The disorders of deglutition were evaluated by cineradiography and manometry which showed deficient relaxation of the superior esophageal sphincter and delayed initiation of the pharyngeal phase; intrapharyngeal propulsion was preserved. On the basis of these findings cricopharyngeal myotomy was performed with subsequent improvement of the disorders. Treatment with doxycycline was prescribed. The significance of these deglutition disorders as regards infection and neurology is discussed and it should have therapeutic implications.

Aged↗
PubMed1996

[An oropharyngeal-esophageal scintigraphic study of deglutition].

The aim of the present work was to evaluate whether oro-pharyngeal-esophageal scintigraphy could be used in the dynamic study of the various phases of deglutition and to determine whether it could be applied in otorhinolaryngological practice along with videofluoroscopy and videoendoscopy. The patients were divided into four different groups according to clinical features and the scintigraphic data were analyzed on this basis. Emphasis is placed on the ease of this technique, its tolerability and the low level of radiation. It is pointed out that scintigraphy is quite useful in determinating the exact percentage of the bolus inhaled into the trachealbronchial branch and in measuring the transit time of the various phases of deglutition in detail. In patients affected by upper airway-digestive tract neoplasms it is, therefore, possible to make a semiquantitative evaluation of the results of surgery. Moreover, with this method the results of any rehabilitation can be measured as well as the onset of compensation mechanisms.

Aged↗
PubMed1983

Epiglottic dysfunction during deglutition in patients with dysphagia.

Among 250 patients with dysphagial complaints, 83 had dysfunction of the epiglottis as revealed by high-speed cineradiography. Nineteen patients had a totally immobile epiglottis and of these 11 had concomitant pharyngeal constrictor paresis. Sixteen of the patients with immobile epiglottis had misdirected swallowing. An absence of the second movement of the epiglottis during deglutition was registered in 53 patients. Thirteen of these had pharyngeal constrictor paresis and 45 had misdirected swallowing. In 11 patients the epiglottis attained an obliquity of 30 degrees to 90 degrees as seen in the anteroposterior projection during its second movement. One of these had a pharyngeal constrictor paresis, while four had misdirected swallowing. The results of this study indicate that epiglottic dysfunction is common among patients with dysphagia and is often accompanied by other functional abnormalities.

Adult↗
PubMed1995

An electrophysiological investigation of deglutition in man.

This article describes a combined electrophysiological and mechanical method used to measure laryngeal movements and related submental EMG activity during swallowing. The mechanical upward and downward movements of the larynx were detected using a piezoelectric sensor while the submental integrated EMG (SM-EMG) was recorded. Measurements were performed in 29 human subjects. The interval between the onsets of the two sensor signal deflections was used as a measure of the time the larynx remained in its superior position during swallowing. In 10 subjects, the cricopharyngeus muscle (CP) of the upper esophageal spinchter showed a continuous tonic EMG activity except during swallowing. All the parameters measured were influenced by the type and volume of the bolus material. The method presented in this study proved its usefulness in the study of the physiology of deglutition as well as in its objective clinical evaluation in patients with dysphagia.

Adult↗
PubMed1997

Comparative review of techniques for recording respiratory events at rest and during deglutition.

The coordination between swallowing and respiration is essential for safe feeding, and noninvasive feeding-respiratory instrumentation has been used in feeding and dysphagia assessment. Sometimes there are differences of interpretation of the data produced by the various respiratory monitoring techniques, some of which may be inappropriate for observing the rapid respiratory events associated with deglutition. Following a review of each of the main techniques employed for recording resting, pre-feeding, feeding, and post-feeding respiration on different subject groups (infants, children, and adults), a critical comparison of the methods is illustrated by simultaneous recordings from various respiratory transducers. As a result, a minimal combination of instruments is recommended which can provide the necessary respiratory information for routine feeding assessments in a clinical environment.

Adult↗
PubMed1988

Manofluorography of deglutition after total laryngopharyngectomy.

Manofluorography is a new technique for the evaluation of swallowing that provides simultaneous display of manometry and videofluoroscopy on one video screen. Data are presented from a study of deglutition in 10 patients who had prior total laryngopharyngectomy with replacement by either jejunal graft or gastric pull-up. Factors that enhance bolus passage are the presence of a widely patent graft and an intact swallowing reflex. Factors that impair bolus transit include stricture, jejunal peristalsis, impaired lingual coordination, and stenosis at the anastomotic site. The swallowing patterns of these patients serve as models of the open and closed cavity swallow and illustrate principles of manofluorographic interpretation.

Anastomosis, Surgical↗
PubMed2003

[Development of deglutition aid jelly for oral administration].

Many patients find it difficult to swallow powdery preparations like granules and because of this do not take their medication as prescribed. The difficulty is experienced in particular with dysphagic and geriatric patients, in addition to pediatric patients, especially those who find it difficult to deal with the bitter taste of medicine. It is possible that such problems result in a high incidence of noncompliance and ineffective therapy. In contrast, it is generally known that gelatinous foods like jelly are a favorite with the elderly and infants because their rheological properties make them easy to swallow. We have developed a deglutition aid jelly that can change almost all solid preparations into gelatinous dosage form preparations, which poses no risk of aspiration or spilling from the mouth, and thus is safe. To evaluate the pharmaceutical utility of this jelly, sensory tests and videofluoroscopic assessments were performed in 10 healthy adult volunteers (20-60 years of age). During the sensory tests, this jelly showed significant improvement in diffusion of the powdery preparation in the mouth and of adhesion to the oropharynx and prolonged the time until the bitter taste of the medicine was perceived. During the videofluoroscopic assessments, there were significant changes in the total oropharyngeal transit time (mean -13.04 s) and oral transit time (mean -10.69 s) in the group that received the jelly, suggesting improvement in the initiation of pharyngeal contractions and reduction in the time required for the bolus to transverse the pharynx. In addition, significant improvement in the oral onset of swallowing and a significant reduction in pharyngeal swallowing delay and in the frequency of aspiration were observed in some hospitalized patients with dysphagia. This jelly could therefore contribute to improved compliance in patients who feel burdened by taking oral medications.

Administration, Oral↗
PubMed2001

[Deglutition disorders in the elderly. Management].

GENERAL PRINCIPLES: The management of dysphagia requires multi-disciplinary interventions, implying various procedures, the choice of which depends on the results of the global prior assessment of the patient. General measures for oral hygiene, dental care and the organization of conditions in which meals are taken are essential, particularly for dependent patients. A change in food texture or in viscosity of liquids is a strategy commonly used. However, such changes must depend on objective bases and not unnecessarily penalize patients or expose them to further risks of complications. COMPENSATION AND RE-EDUCATION TECHNIQUES: Various strategies can help to counteract deficient deglutition mechanisms. Among these, adopting a particular position while swallowing is helpful in many dysphagic patients, but may be limited by severe cervical stiffness. The swallow reflex can be enhanced by sensorial stimulation techniques, although they are only effective short-term. Execution of voluntary maneuvers improves efficacy and safety when swallowing, but learning these maneuvers can be difficult or even impossible, even when accepted by the patients and compliance is inconsistent. Re-education techniques are intended to lastingly improve swallowing, but it is difficult to obtain the active participation of many elderly patients. Furthermore, these commonly used techniques lack seriousness and require validation. MISCELLANEOUS PROCEDURES: The efficacy of pharmacological intervention is not clear, other than in certain particular etiological contexts and, as with procedures enhancing the stimulating properties of food and liquids, will obviously be developed in the future. Surgery, or related techniques, provides help in certain specific conditions, notably when an anatomical disorder is responsible for the disorder. Gastrostomy is still controversial, not only with regard to its optimal practical use and its capacity to decrease respiratory infection risks and improve nutritional prognosis, but also with regard to its impact on patients' survival and quality of life.

Age Factors↗
PubMed1994

[Radiologic study of the mechanism of deglutition].

The radiological study of the mechanism has helped to define the physiology of the oral and pharyngeal phase of deglutition. Being a dynamic examination, it is part of the work-up in swallowing disorders, such as cervical dysphagia and inhalation episodes. Among the various techniques available, videofluoroscopy remains the examination of choice.

Deglutition↗
PubMed1994

[Study on deglutition function following total laryngectomy, epiglottoplasty and reconstruction of vocal function].

Twenty-five cases of epiglottoplasty after total laryngectomy were summarized. Only 4 cases presented aspiration for a short period of time. The X-ray films were taken using a cinematograph X-ray unit and a telecontrol X-ray unit. The results demonstrated that in non aspirator cases and 1 healthy man, the tongue and the larynx (or reconstructive new larynx) coordinated closely and there was better glossolaryngeal close-knit degree, but in aspirator cases there was no coordination between them. The study proved that the deglutition a coordinative motion of hyoid muscles, laryngeal muscles and the nerves supplying them. So it is important that the hyoid bone, its superior muscles and pharyngeal constrictors should be preserved during the operation.

Cineradiography↗
PubMed1998

[Deglutition: physiologic and neurophysiologic aspects].

Swallowing is a complex motor sequence involving the coordinated contraction of many muscles of the buccopharyngeal cavity, the larynx and the oesophagus. Most of the muscles are striated except those of the distal oesophagus which, in human and some other species, are of the smooth type. During swallowing, usually divided into a buccopharyngeal and an oesophageal stage (peristalsis), the sequential activity of the muscles results from motor orders programmed by a rhombencephalic swallowing centre and conveyed to the periphery by efferent fibres belonging to various pairs of cranial nerves (Vth, VIIth, Xth, XIIth). Apart from the motor nuclei of the cranial nerves, the swallowing centre contains an interneurone network responsible for the programming of deglutition. During swallowing, these interneurones (INs) exhibit a sequential activity quite parallel to that of muscles, and persisting in the absence of sensory feedback. The "swallowing INs" are located in two medullary regions: (1) a dorsal region including the nucleus of the solitary tract and the adjacent reticular formation, (2) a ventral region corresponding to the reticular formation surrounding the nucleus ambiguus. The dorsal INs are involved in the initiation and the programming of swallowing. The ventral INs receive their swallowing input from the dorsal neurones and are probably switching neurones that distribute the swallowing excitation to the various pools of motoneurones. The swallowing program can be triggered by inputs originating from either the peripheral reflexogenic areas or the supramedullary structures (cerebral cortex, basal ganglia and hypothalamus). Under physiological circumstances swallowing program is continuously modified by peripheral afferents (expecially muscular) that adjust the force and the timming of contractions to the size of the swallowed bolus. In addition, an important operating feature of the programming network consists of a functionnal polarization so that the activity of proximal portions of the swallowing tract inhibits that of distal portions. This polarization implies the existence of inhibitory connections between interneurones, that could be responsible for the series of delays typical fo swallowing contractile sequence, by generating delayed desinhibitions followed by post inhibitory excitations. Lastly, the sensitive messages that trigger and adjust the swallowing program are at the same time conveyed to higher nervous structures allowing the so called "voluntary" swallow and the integration of swallowing in the ingestive behavior. Disruption of this central loop is likely the source of swallowing disorders (dysphagia) following lesion of cortical or subcortical structures.

Animals↗
PubMedDate not supplied

Manofluorography of deglutition after supraglottic laryngectomy.

Manofluorography (mano: manometry, fluoro: videofluoroscopy, graphy: picture) provides a simultaneous display of manometry and fluoroscopy on one video screen. This study uses manofluorography to analyze the swallowing patterns of nine patients who had undergone supraglottic laryngectomy. The results show that during swallowing the pharyngeal mechanism for preventing aspiration depends upon three processes: (1) tight lingual-laryngeal contact, (2) coordination of the swallowing reflex, and (3) tongue base and pharyngeal constrictor clearing of the hypopharynx and laryngeal inlet. Anterior suspension of the larynx under the tongue base serves to improve lingual-laryngeal contact. This close contact during deglutition protects the airway from the bolus and also opens the postcricoid region, aiding bolus passage into the esophagus. Impairment of the swallowing reflex, which can cause severe aspiration before the swallowing reflex is triggered, can be rehabilitated by swallowing therapy. Minor aspiration is commonly caused by impaired clearing of the superior hypopharynx after supraglottic laryngectomy.

Deglutition Disorders↗
PubMedDate not supplied

Patterns of lingual tissue deformation associated with bolus containment and propulsion during deglutition as determined by echo-planar MRI.

Disordered lingual function is a common clinical attribute of patients with oropharyngeal dysphagia. To determine physiologic patterns of lingual tissue motion during swallowing, we imaged the actively deforming tongue during water bolus swallows with sequential single-slice sagittal orientation echo-planar imaging. At rest, with the bolus contained in the oral cavity before swallow initiation, the tongue displayed a characteristic curved configuration consisting of a convex surface (anterior to the bolus) in continuity with a concave surface (containing the bolus) and a posterior-located convex surface (comprising the tongue base). With swallow initiation, the previously deformed tongue underwent rapid biphasic displacement: (a) superior displacement of the anterior tongue and deepening of the midposterior-located bolus-containing concavity, resulting in a laterally beveled surface encompassing the bolus; and (b) retrograde displacement of the configured tissue, resulting in clearance of the bolus from the oral cavity to the oropharynx. These findings indicate that deglutitive tongue action can be depicted by echo-planar imaging as a series of deformative surface modifications, which are related to the activity of intrinsic and extrinsic lingual muscles.

Adult↗
PubMed1995

Dysphagia after pharyngolaryngeal cancer surgery. Part I: Pathophysiology of postsurgical deglutition.

Eighty-one patients were examined after laryngopharyngeal cancer surgery with a sequential computer manometry system using 4-channel-pressure probes. The general swallowing coordination is neither a matter of the oropharyngeal pressure thrust nor of the pharyngeal transit time, but mainly depends on swallowing initiation. The points of interest are both the pharyngeal inlet and outlet. The topographic correlates are the base of the tongue and the upper esophageal sphincter (UES). Resections of the base of the tongue lead to a decrease of volume available for pressure generation, thus reducing the tongue driving force. The swallowing reflex is uncoordinated resulting in dyskinesia of the UES. Compensation may be achieved with a stronger oropharyngeal thrust and/or repeated swallows. Distal resections alter the pharyngoesophageal segment so that a functional obstruction results, combined with lower pressure amplitudes in the hypopharynx, reducing the pressure gradient necessary for bolus flow. This increasing resistance can be overcome by higher propulsive forces in the base of the tongue region. In case of additional lingual defects, deglutition is subject to decompensation, highlighting the major role of the tongue as a pressure generator for bolus passage.

Deglutition Disorders↗
PubMed1993

Dynamic control of the larynx and future perspectives in the management of deglutitive aspiration.

The approach to deglutitive aspiration presented in this article is original. It permitted restoring the dynamic nature of the swallowing process in immobile largynges, a situation found when function has been abolished through central neurological deficit. The necessity, in the author's view, for a miniaturized electronic system bypassing the diseased centers able to produce tight glottic closure in a canine model during pharyngeal stimulation is emphasized. There is hope that we may ultimately move towards human implantation if the proposed electronics will be well tolerated over time.

Deglutition Disorders↗
PubMed1982

Movement of the epiglottis during deglutition. A cineradiographic study.

The movements of epiglottis during swallowing of barium were studied by high-speed cineradiography in 150 volunteers who had no dysphagia. In 137 individuals the epiglottis tilted down in a two-step fashion during deglutition. The first movement from an upright to transverse position was accomplished by elevation of the larynx and approximation of the hyoid bone and thyroid cartilage. This first movement is evidently a passive one and induced by the muscles that lift the hyoid bone. The second movement of the epiglottis, from transverse to an inverted position, occurs later in swallowing and seems related to contraction of the thyroepiglottic muscle. The second epiglottic movement was absent in 7 individuals, and 6 others demonstrated obliquity of their epiglottis (30-90 degrees) when studied in AP projection.

Adult↗
PubMed1997

Dysphagia--ingestion or deglutition?: a proposed paradigm.

The current classifications of dysphagia are based on local structural or central nervous system pathology causing dysfunction of the aerodigestive tract. The result is a clinical science grounded in the analysis of the swallow with its lingual, pharyngeal, and esophageal stages. Adding bolus preparation to the swallowing paradigm improves but still constrains the study of dysphagia and treatment of the dysphagic patient. Those pre-oral facets of mealtime behavior that may evoke or exacerbate dysphagia remain beyond the existing classification boundaries imposed by the conceptual swallow and anatomic aerodigestive tract. We offer a more inclusive strategy for investigating dysphagia based on a five-stage process of ingestion: pre-oral (anticipatory), preparatory, lingual, pharyngeal, and esophageal. The first stage considers the interaction of pre-oral motor, cognitive, psychosocial, and somataesthetic elements engendered by the meal. The limited literature regarding the interaction of the pre-oral stage with other ingestion stages, in both normal subjects and patients with cortical, basal ganglia, and psychogenic diseases, is reviewed. The neurophysiologic and clinical justifications for embracing a pre-oral stage, and thus for the paradigm shift from deglutition to ingestion, are presented.

Deglutition Disorders↗
PubMed1998

[Deglutition disorders].

Dysphagia is related to the impairment of food passage from the mouth to the stomach. Globus pharyngis implies the frequent and often painful sensation of a lump in the throat that usually does not interfere with swallowing and may even be relieved by food intake. The diagnosis is based upon a careful history, clinical examination, endoscopy, dynamic imaging (videofluoroscopy, cinematography, videosonography) and electrophysiologic procedures (including pharyngoesophageal manometry, electromyography and pH determinations). Structural lesions of the cervical spine such as diffuse idiopathic skeletal hyperostosis are rare causes of dysphagia. Dysphagia following anterior cervical fusion as well as globus and dysphonia due to dysfunction of the vertebral joints are more likely. Symptoms with swallowing fluids indicate a neurogenic origin. Dyscoordinated swallowing, nasal reflux, dysphonia or general weakness may also occur. Chronic aspiration with respiratory compromize is the main consequence in a variety of neurological disorders as well as in cases of postsurgical dysphagia. Relaxation of the upper esophageal sphincter indicates coordinated muscle movement between the pharynx and esophagus. Dysfunction of the pharyngoesophageal segment may lead to cricopharyngeal achalasia. A dyskinetic sphincter commonly represents an extrapharyngeal cause: i.e., disease associated with gastroesophageal reflux. Disorders of the esophageal phase of deglutition can produce retrosternal pain, heartburn, regurgitation and vomiting, as well as laryngeal and respiratory signs. Esophageal motility disorders include lower achalasia, tumors, peptic strictures, inflammatory diseases, drug-induced ulcers, rings and webs. Motility disorders present with aperistaltic, spontaneous contractions, diffuse esophagospasm, or a hypermotile esophagus. Gastroesophageal reflux with esophagitis must always be excluded, especially in patients with a globus sensation. The multiple features of the appearance of the symptoms of dysphagia and globus makes multidisciplinary approach necessary in order to establish a diagnosis and begin effective treatment.

Deglutition Disorders↗