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PubMed2006

The challenge of mastication: preparing a bolus suitable for deglutition.

The main function of mastication is to transform a solid food into a bolus that can be swallowed safely. The bolus characteristics such as particles size or cohesiveness, are continuously sensed during mastication and they are important in initiating deglutition. This study examined the following question: What is the condition of the bolus just before swallowing? Ten subjects with normal dentition aged 37.5 +/- 3.7 years were asked to chew without swallowing six different foods (three nuts and three vegetables) while the number of cycles and the duration of the sequence were recorded. The particle size distribution shown by the expectorated food bolus just before swallowing was examined by image analysis. The results showed that, for a given food, the sizes of the bolus particles just before swallowing were comparable in all subjects. However, the number of cycles and duration of the sequence varied between subjects. Taken together these data strongly suggest that the granularity of the bolus before swallowing has to reach a predetermined state which is obtained by using an individual chewing strategy. This suggests that the bolus structure reflects a key factor for homeostasis and explains the large interindividual variability of the mastication physiologic parameters.

Adult↗
PubMed1996

Coordination between respiration and deglutition in a preterm infant mammal, Sus scrofa.

In adult mammals, the path of a swallowed bolus of solid food crosses the laryngeal opening, so that coordination between respiration and deglutition is critical for airway protection. The nature of such coordination in preterm, low-birth-weight infants with immature nervous systems, is not clear. Using preterm pigs as a model, two measures of respiration were recorded and then coordinated with a high-resolution cineradiographic record of swallowing. Swallows, divided into three distinct events, began before inhalation ended, but expiration did not start until after the milk had passed around the laryngeal opening. These results support the idea that a high degree of coordination between swallowing and respiration exists in preterm infant pigs, although other aspects of the nervous system have not fully matured.

Animals↗
PubMed1988

Upper esophageal sphincter function during deglutition.

Upper esophageal sphincter function was investigated during swallows of graded volumes in 8 normal volunteers. Concurrent recordings of video-fluoroscopic and manometric studies were obtained and correlated with each other by means of a videotimer. Maximal upper esophageal sphincter (UES) pressure was typically located 1.5 cm distal to the air-tissue interface between the hypopharynx and the proximal margin of the sphincter. The region in which UES pressure was greater than or equal to 50% maximal averaged 1.0 cm in length. Thus, the physiologic high-pressure zone of the UES corresponds in size and location to that of the cricopharyngeus muscle. Fluoroscopic analysis of sphincter movement indicated that the sphincter high-pressure zone moved 2.0-2.5 cm orally during swallowing and that the magnitude of the orad movement was directly related to the volume of barium swallowed. The maximal anterior-posterior diameter of sphincter opening during a swallow ranged from 0.9 to 1.5 cm and was also directly related to the volume swallowed. The intervals of UES opening and relaxation increased significantly with increasing bolus volume; the duration of UES relaxation ranged from a mean of 0.37 s for dry swallows to 0.65 s for 20-ml swallows. Thus, the dynamics of UES function during deglutition are dependent upon the volume of the swallowed bolus. Larger bolus volumes are accommodated by both an increased diameter of sphincter opening and by prolongation of the interval of sphincter relaxation. Analysis of the timing of other reference points within the pharyngeal swallow sequence indicated that as the manometric interval of UES relaxation increased, the period of laryngeal elevation was prolonged, the UES relaxed earlier and contracted later, and the interval between the onset of laryngeal elevation and hypopharyngeal contraction increased.

Adolescent↗
PubMed1987

Excitatory action of 5-HT on deglutitive substrates in the rat solitary complex.

The excitatory effect of serotonin (5-HT) on the pharyngeal stage of swallowing was investigated in urethane anaesthetised rats with respect to the involvement of neural substrates located in the central and intermediolateral regions of the nucleus tractus solitarii (NTS). Micropneumophoretic ejection of 5-HT 5-50 pmol either produced deglutitory responses or selectively facilitated the S-glutamate-evoked pharyngeal responses when applied in 1-10 pmol prepulses. The excitatory/facilitatory effect of 5-HT was enhanced by intravenous threshold doses of the 5-HT-mimetic, quipazine (0.3-1 mumol/kg) and reversibly blocked by the 5-HT2-receptor antagonists, methysergide, metergoline and ketanserin. 5-HT doses exceeding 10-60 pmol gave rise to a non-selective reversible inhibition of glutamate- and acetylcholine (ACh)-evoked pharyngeal or oesophageal responses which was not prevented or reversed by 5-HT2-receptor antagonists, but was readily overcome by increasing the amount of glutamate or ACh ejected. Non-selective deglutitive inhibition after high doses of 5-HT could, therefore, result from neuronal desensitization secondary to excessive stimulation or activation of a different type of 5-HT receptor. These results corroborate an excitatory role of 5-HT in both reflex and automatic swallowing and demonstrate that the NTS is a major site of serotoninergic facilitation of swallowing.

Acetylcholine↗
PubMed1997

Coordination of deglutitive glottal function and pharyngeal bolus transit during normal eating.

BACKGROUND & AIMS: Deglutitive glottal function during the preparatory phase of swallowing and its coordination with bolus transit during normal eating are important for airway protection. The aim of this study was to examine this coordination during consumption of a normal meal. METHODS: Fifteen healthy volunteers were studied using a videoendoscopic and videofluoroscopic technique. RESULTS: A total of 207 liquid and 470 solid bolus swallows were analyzed. In 60% of liquid and 76% of solid food swallows, the bolus was seen in the pharynx before a swallow was initiated. Entry of boluses into the pharynx was associated with brief partial adduction of the vocal cords. Solid food entered and traversed the pharynx at the midline, whereas liquid bolus was split around the larynx and rejoined in the hypopharynx. Swallowing was initiated significantly earlier when bolus made contact with the upper third of the epiglottis compared with vallecula or pyriform sinuses. CONCLUSIONS: In more than half of the instances, during normal eating, food enters the pharynx during the preparatory phase before a swallow is initiated, the path of pharyngeal transit of solid bolus is different from that of liquid bolus, and the epiglottal edge appears to be the most sensitive trigger zone for swallowing.

Adult↗
PubMed2006

[Dysphagia caused by neurogenic deglutition disorders and diffuse idiopathic skeletal hyperostosis (DISH)].

BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH) may lead to dysphagia caused by osteophytes of the cervical spine. Osteophytes can be resected transorally or transcervically, but operative ablation should not be indicated generously because of the threat of severe complications. PATIENT: A fifty-year-old man with dysphagia and loss of weight of 15 kg in the last three months is presented. He also suffered from a brain damage during infancy which caused grand-mal-seizures. One seizure lead to cardiac arrest which required cardio-pulmonary resuscitation and subsequent tracheostomy. A spheric tumor of the posterior pharyngeal wall could be seen endoscopically, it appeared radiologically as an osteophytic formation of the segments C (3) - C (5). Ossification of the anterior longitudinal ligament was also seen. Diagnosis of DISH was made on the basis of these results. Contrast imaging of the esophagus and videofluoroscopy showed aspiration in terms of neurogenic disorders. The patient received a percutaneous gastrostomy after his case was discussed with neurologic and orthopaedic colleagues, because a causal therapy of the combined disease seemed to be impossible. CONCLUSION: Dysphagia in the presented case was caused by a combination of neurogenic deglutition disorders and oropharyngeal obstruction through osteophytes. Surgical removal of the osteophytes was not indicated because it would have put the patient at a certain risk, but only a part of the underlying problem would have been removed. Symptomatic therapy with a gastrostomy secures normocaloric diet. The patient's weight remained stable and he can follow his habitual daily routine.

Cervical Vertebrae↗
PubMed1996

Mandibular reference position: chin-point guided closure vs. final deglutition.

The study investigated two mandibular positions based upon computerized axiography recordings of hinge axis movements of 262 subjects. Next to the well-known guided closure position RP (reference position by chin-point guidance), the position of final deglutition (FD) was quantified. FD represented the hinge axis position at the end of the swallowing movement. The results elicited average linear distances of 0.32 +/- 0.43 mm on the right and 0.33 +/- 0.40 mm on the left side between both positions in the sagittal plane. The average distance in the frontal plane was 0.02 mm (right) and 0.04 mm (left). Approximately 46 per cent of FD recordings were found anterior and inferior to RP, and showed significant difference to posterior and anterior-superior FD recordings. The replicability of both positions was tested on 53 subjects and averaged 0.04 mm (FD) and 0.09 mm (RP). Average deviations of repeated recordings within the subject ranged from 0.07 to 0.47 mm (FD) and 0.07 to 0.57 mm (RP) for each spatial direction. The results of this study showed a relative coincidence of an average FD and RP Variation of FD in anterior inferior direction questioned the clinical reliability of FD to reassure the guided closure position.

Adolescent↗
PubMed1992

Deglutition in elderly patients with dementia: findings of videofluorographic evaluation and impact on staging and management.

Oral and pharyngeal function in 131 institutionalized elderly patients with advanced dementia was evaluated by means of videofluoroscopic deglutition examination (VDE). Findings were normal in only nine (7%) patients. Oral-stage dysfunction was observed in 93 (71%) patients, pharyngeal dysfunction in 56 (43%), and pharyngoesophageal-segment abnormalities in 43 (33%). Multiple-stage dysfunction was noted in 55 (42%) patients. Major aspiration of contrast medium was present in 31 patients, and minor aspiration in 66. Evaluation of VDE findings prompted a change in clinical staging (degree of impairment) in 40 patients and substantial alteration in treatment planning in 28. At clinical bedside evaluation, the degree of bolus misdirection was overestimated in 19 patients with minor aspiration and underestimated in seven with major aspiration. Dementia is often associated with oral and pharyngeal impairment, and VDE can be important in diagnosis and treatment.

Aged↗
PubMed2004

Absence of a deglutitive inhibition equivalent with secondary peristalsis.

This study aimed to determine the interactions between closely paired swallow-induced primary peristalsis (PP) and air injection-induced secondary peristalsis (SP). Ten subjects (7 men, 18-42 yr) were studied using a catheter, including two sleeves (upper and lower esophageal sphincters), a midesophageal infusion port, and seven esophageal and two pharyngeal recording sites. Ten iterations of PP and SP were induced by 5-ml water swallows and 20-ml intraesophageal air injections, respectively. Thereafter, the interactions between PP and SP, separated by 1- to 12-s intervals, were studied in all four possible sequences: paired swallows, swallow preceded by air injection, air injection preceded by swallow, and paired air injections. Tracings were analyzed for lower esophageal sphincter relaxation, presence and integrity of peristalsis, and event interaction. Eight subjects with success rates of both >/=90% PP and >/=80% SP were analyzed (PP 97 +/- 2%, SP 90 +/- 3%). During paired PP interactions and SP followed by PP, the first sequence was inhibited by the second with intervals < 4-6 s. However, no inhibition of the first peristaltic sequence was found in either PP followed by SP trials or SP followed by air injection. In contrast to swallowing or proximal esophageal distention, air injection into the lumen of the midesophagus does not inhibit an ongoing peristaltic event. Being that the elicitation of SP in the smooth muscle esophagus is intramurally mediated, this suggests that deglutitive inhibition is a centrally mediated phenomenon rather than an intrinsic property of peristalsis.

Adult↗
PubMed1992

Coordination of deglutition and phases of respiration: effect of aging, tachypnea, bolus volume, and chronic obstructive pulmonary disease.

The effects of aging, tachypnea, bolus volume, and chronic obstructive pulmonary disease on the coordination of swallowing with the phases of respiration were studied by concurrent respirography and submental surface electromyography. Study findings showed that in young healthy volunteers, during rest, there is preferential coupling of subconscious swallowing with the expiratory phase of continuous respiration. This preferential coupling of swallowing with expiration was found to increase relative to other phases of respiration during water swallows and tachypnea (P < 0.05). Respiratory phase occurrence of swallowing and postdeglutitive resumption of respiration during exacerbation of chronic obstructive pulmonary disease was found to be significantly different compared with the basal state (P < 0.05). Respiratory phase occurrence of subconscious swallowing in the elderly was found to be different from the young (P < 0.05). Position had no significant effect on the coordination of swallowing and phases of respiration. We concluded that in resting young volunteers the majority of deglutitions are coupled with the expiratory phase of swallowing. This coupling is increased in frequency by the presence of a liquid bolus and tachypnea. And finally, age and chronic obstructive pulmonary disease alter this coordination significantly.

Adult↗
PubMed1994

Influence of mucosal receptors on deglutitive regulation of pharyngeal and upper esophageal sphincter function.

The potential influence of mucosal sensory receptors on the regulation of oral-pharyngeal swallow events was studied in 15 healthy volunteers using simultaneous videoradiography and manometry. We determined the effects of selective pharyngeal and oral plus pharyngeal anesthesia on the following temporal and manometric measures in response to liquid and viscous swallows: regional transit and clearance times; motion of hyoid and larynx; upper esophageal sphincter relaxation, opening, and closure; and pharyngeal contraction wave characteristics. Under the influence of mucosal anesthesia no subjects demonstrated aspiration during deglutition. Neither regional transit and clearance times nor pharyngosphincteric coordination was influenced significantly by pharyngeal mucosal anesthesia or oral plus pharyngeal anesthesia. Although midpharyngeal and distal pharyngeal contraction amplitudes were not influenced by mucosal anesthesia, midpharyngeal contraction wave duration was reduced significantly by both pharyngeal (P = 0.02) and oral plus pharyngeal anesthesia (P = 0.0005). We conclude that 1) neither elicitation of the pharyngeal swallow response nor temporal regulation among swallow events is dependent on mucosal sensory receptors and 2) duration of the pharyngeal contraction is influenced by sensory input from the oral-pharyngeal mucosa.

Adolescent↗
PubMed1997

Influence of altered tongue contour and position on deglutitive pharyngeal and UES function.

The potential influence of altered lingual position and contour during the bolus loading phase of the swallow in mediating the swallowed bolus volume-dependent regulation of upper esophageal sphincter (UES) relaxation and opening was studied in 15 healthy volunteers using simultaneous videoradiography and manometry. A maxillary dental splint modulated tongue deformity during the early oral phase of deglutition. We examined the effect of the splint and swallowed bolus density on bolus volume-dependent changes in the timing of events in the swallow sequence and on hypopharyngeal intrabolus and midpharyngeal pressures. Peak mid-pharyngeal pressure (P = 0.001) and hypopharyngeal intrabolus pressure (P = 0.04) were significantly reduced by the splint. The normal volume-dependent earlier onset of sphincter relaxation and opening was preserved with the splint in situ. The splint significantly delayed the onset of hyoid motion and UES relaxation and opening without influencing transit times or total swallow duration. Alterations in tongue contour and position reduce intrabolus pressure and pharyngeal contraction without influencing normal bolus volume-dependent regulation of timing of UES relaxation and opening.

Adult↗
PubMed2001

Swallow-related cerebral cortical activity maps are not specific to deglutition.

Cortical representation of swallow-related motor tasks has not been systematically investigated. In this study, we elucidated and compared these cortical representations to those of volitional swallow using block-trial and single-trial methods. Fourteen volunteers were studied by functional magnetic resonance imaging. Cortical activation during both swallowing and swallow-related motor tasks that can be performed independent of swallowing, such as jaw clenching, lip pursing, and tongue rolling, was found in four general areas: the anterior cingulate, motor/premotor cortex, insula, and occipital/parietal region corresponding to Brodmann's areas 7, 19, and 31. Regions of activity, volume of activated voxels, and increases in signal intensity were found to be similar between volitional swallow and swallow-related motor tasks. These findings, using both block-trial and single-trial techniques, suggest that cerebral cortical regions activated during swallowing may not be specific to deglutitive function.

Adult↗
PubMedDate not supplied

The upper esophageal sphincter during normal deglutition. A simultaneous cineradiographic and manometric investigation.

The upper esophageal sphincter was studied during deglutition in 7 healthy subjects using simultaneous cineradiography and manometry. The pressure measuring device consisted of 3 sensors distally placed, and separated by 10 mm. They recorded pressure obliquely to the right at an angle of 15 to 45 degrees anteriorly. During the swallowing sequence a pressure sensor initially placed in the high pressure zone of the sphincter easily slid out of position due to asynchronous movements of the sphincter and the pressure measuring device. These movements can result in erroneous interpretation of pressure recordings. Continuous radiologic monitoring during the entire swallowing sequence thus seems to be mandatory. Immediately before the bolus entered the upper esophageal sphincter, the sphincter relaxed and low or even negative pressures were registered. When the bolus had passed onwards the sphincter contracted gradually, to resume its pre-swallow pressure.

Adult↗
PubMed2002

Oropharyngeal deglutition in stable COPD.

STUDY OBJECTIVES: The aim of this study was to examine deglutition in stable patients with COPD and lung hyperinflation. DESIGN: Twenty consecutive, eligible COPD patients with an FEV(1) < or = 65% of predicted and a total lung capacity > or = 120% of predicted were enrolled prospectively. INTERVENTION: Patients received a detailed videofluoroscopic evaluation of oropharyngeal swallowing and were compared to 20 age-matched and sex-matched historical control subjects. SETTING: An outpatient pulmonary clinic at a Veterans Affairs Medical Center. MEASUREMENTS AND RESULTS: The mean total lung capacity, functional residual capacity, and residual volume for the patients were 128% of predicted, 168% of predicted, and 218% of predicted, respectively. The mean FEV(1) was 39% of predicted. There was no evidence of tracheal aspiration in either group. The laryngeal position at rest measured relative to the cervical vertebrae was not different between groups. The maximal laryngeal elevation during swallowing was significantly lower in patients with COPD (p < 0.001). Patients with COPD exhibited more frequent use of spontaneous protective swallowing maneuvers such as longer duration of airway closure and earlier laryngeal closure relative to the cricopharyngeal opening than did control subjects (p < 0.05). CONCLUSIONS: We conclude that hyperinflated patients with COPD have an altered swallowing physiology. We suspect that the protective alterations in swallowing physiology (swallow maneuvers) may reduce the risk of aspiration. However, these swallowing maneuvers may not be useful during an exacerbation and may require further research.

Aged↗
PubMed1991

Deglutition syncope with coexistent carotid sinus hypersensitivity.

A 63-year-old man had symptomatic deglutition-induced atrioventricular (A-V) block. There was also a coexistent mixed type carotid sinus hypersensitivity presenting as A-V block. No A-V nodal dysfunction was revealed during electrophysiologic studies. The vasodepressor response to carotid massage implies a central vagal hyperresponsiveness, which can also explain the cardioinhibitory responses to swallowing and carotid sinus massage, both possibly unmasked by posterior myocardial infarction.

Blood Pressure↗
PubMed1999

[Mechanisms smoothing deglutition disorders after oral cancer surgery].

Compensatory treatment for oropharyngeal dysphagia includes postural changes and reducing the risk of aspiration. Some of compensatory maneuvers are introduced spontaneously by the ill at first weeks after oral cavity tumour resection. On the basis of roentgenotelevision examination of deglutition in 82 patients we detected mechanisms with intention to minimize swallowing disturbances. Variability of their occurrence and differences in their efficiency should be emphasized, as well as essential synchronization of laryngeal closure with emptying of pharynx and opening upper oesophageal sphincter for swallowing efficiency. The valuation of compensatory maneuvers introduced spontaneously by the ill was defined as an important part of swallowing rehabilitation.

Adult↗
PubMed2000

[The course of oropharyngeal stage of deglutition after partial supracricoid laryngectomies. Computerized analysis of radiographic imaging. Preliminary report].

On a pilot basis the performed analysis covered the pharyngeal phase of the deglutition act in five patients, in whom supracricoid laryngectomies were carried out due to carcinoma of the larynx. The rentgenocinematographic (Rtgc) examinations were made half a year after the operations, while in 1 patient the studies were carried out twice, the second being performed two years after the operative procedure thus altogether 6 examinations Rtgc were performed. Computerized topocinetic analysis of images Rtgc was made intended for further considerations and measurements, and concurrently assessing the position of the left-behind anatomical structures, the pathway passed by the studied structures, the velocity, the projection of the encircled kinetic path, as well as the distance of individual structures in respect to each other during a complete cycle of the pharyngeal phase. The provided description highlights the significance of good mobility of the left structures in the food bolus passage trough the lower pharynx and other, than that after supraglottal laryngectomy, mechanism protecting the lower respiratory tracts against food leakage into them.

Carcinoma, Squamous Cell↗