Adaptation, compensation, and decompensation of the pharyngeal swallow

1985 ◽  
Vol 10 (1) ◽  
pp. 235-239 ◽  
Author(s):  
David W. Buchholz ◽  
James F. Bosma ◽  
Martin W. Donner
Keyword(s):  
Pharyngeal Swallow

Swallow Pattern Generator Reconfiguration of the Respiratory Neural Network

2009 ◽  
Vol 18 (1) ◽  
pp. 3-12
Author(s):  
Andrea Vovka ◽  
Paul W. Davenport ◽  
Karen Wheeler-Hegland ◽  
Kendall F. Morris ◽  
Christine M. Sapienza ◽  
...  
Keyword(s):  
Behavioral Control ◽  
Upper Airway ◽  
Pattern Generator ◽  
Breathing Patterns ◽  
Motor Patterns ◽  
Control Assembly ◽  
Pharyngeal Swallow ◽  
Laryngeal Vestibule ◽  
Lower Airways ◽  
Swallow Apnea

Abstract When the nasal and oral passages converge and a bolus enters the pharynx, it is critical that breathing and swallow motor patterns become integrated to allow safe passage of the bolus through the pharynx. Breathing patterns must be reconfigured to inhibit inspiration, and upper airway muscle activity must be recruited and reconfigured to close the glottis and laryngeal vestibule, invert the epiglottis, and ultimately protect the lower airways. Failure to close and protect the glottal opening to the lower airways, or loss of the integration and coordination of swallow and breathing, increases the risk of penetration or aspiration. A neural swallow central pattern generator (CPG) controls the pharyngeal swallow phase and is located in the medulla. We propose that this swallow CPG is functionally organized in a holarchical behavioral control assembly (BCA) and is recruited with pharyngeal swallow. The swallow BCA holon reconfigures the respiratory CPG to produce the stereotypical swallow breathing pattern, consisting of swallow apnea during swallowing followed by prolongation of expiration following swallow. The timing of swallow apnea and the duration of expiration is a function of the presence of the bolus in the pharynx, size of the bolus, bolus consistency, breath cycle, ventilatory state and disease.

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

1994 ◽  
Vol 267 (4) ◽  
pp. G644-G649 ◽  
Author(s):  
G. N. Ali ◽  
T. M. Laundl ◽  
K. L. Wallace ◽  
D. W. Shaw ◽  
D. J. Decarle ◽  
...  
Keyword(s):  
Sensory Input ◽  
Upper Esophageal Sphincter ◽  
Sensory Receptors ◽  
Potential Influence ◽  
Sphincter Function ◽  
Temporal Regulation ◽  
Wave Characteristics ◽  
Pharyngeal Swallow ◽  
Esophageal Sphincter ◽  
Contraction Wave

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.

Cineradiography in closed and open pharyngeal swallow

1988 ◽  
Vol 29 (4) ◽  
pp. 407-410 ◽  
Author(s):  
M. Birch-Iensen ◽  
P. S. Borgström ◽  
O. Ekberg
Keyword(s):  
Pharyngeal Swallow

Pharyngeal swallowing elicited by fluid infusion: role of volition and vallecular containment

1996 ◽  
Vol 270 (2) ◽  
pp. G347-G354 ◽  
Author(s):  
P. Pouderoux ◽  
J. A. Logemann ◽  
P. J. Kahrilas
Keyword(s):  
Spatial Distribution ◽  
Infusion Rate ◽  
Volitional Control ◽  
Flow Rates ◽  
Fluid Infusion ◽  
Water Infusion ◽  
Pharyngeal Swallow ◽  
Pharyngeal Swallowing ◽  
Temperature Water

Nonalimentary swallows minimize aspiration by clearing accumulated fluid from the pharynx. This study aimed to define 1) the pharyngeal sensory field to elicit swallowing and 2) the effect of infusion rate, volition, taste, and temperature on pharyngeal swallows. Test solutions were directed into the valleculae at 6.5, 11.5, and 32 ml/min through a catheter in eight healthy volunteers. Deglutition was signaled with electromyography and electroglottography. Spatial distribution of infusate before swallowing was studied using videofluoroscopy coupled with a video timer. Volitional control was assessed with rapid or restrained swallows. Pharyngeal swallow latency decreased as the instillation rate increased, was potently modified with volition, and was unchanged by infusate taste or temperature. Water infusion into the valleculae did not trigger pharyngeal swallowing until liquids overflowed and reached the aryepiglottic folds or pyriform sinuses. The variation in swallow latency among flow rates was mainly due to the duration of liquid containment within the valleculae. This suggests that the valleculae act to contain pharyngeal secretions and residue and prevent aspiration by diverting their contents around the larynx before swallowing.

Physiologic Effects of Open and Closed Tracheostomy Tubes on the Pharyngeal Swallow

2003 ◽  
Vol 112 (2) ◽  
pp. 143-152 ◽  
Author(s):  
Roxann Diez Gross ◽  
Jeanne Mahlmann ◽  
Judith P. Grayhack
Keyword(s):  
Tracheostomy Tube ◽  
Air Pressure ◽  
Subglottic Air Pressure ◽  
Laryngeal Penetration ◽  
Closed Tube ◽  
Pharyngeal Swallow ◽  
Series Of Experiments ◽  
Pharyngeal Swallowing ◽  
Tracheostomy Tubes ◽  
Swallow Function

Studies linking aspiration and dysphagia to an open tracheostomy tube exemplify the possibility that the larynx may have an influence on oropharyngeal swallow function. Experiments addressing the effects of tracheostomy tube occlusion during the swallow have looked at the presence and severity of aspiration, but few have included measurements that capture the changes in swallowing physiology. Also, hypotheses for the importance of near-normal subglottic air pressure during the swallow have not been offered to date. As such, the aim of this study was to compare the depth of laryngeal penetration, bolus speed, and duration of pharyngeal muscle contraction during the swallow in individuals with tracheostomy tubes while their tubes were open and closed. The results of this series of experiments indicate that within the same tracheostomized patient, pharyngeal swallowing physiology is measurably different in the absence of subglottic air pressure (open tube) as compared to the closed tube condition.

Short-Term Effects of Cold Liquids on the Pharyngeal Swallow in Preterm Infants with Dysphagia: A Pilot Study

Dysphagia ◽  
2018 ◽  
Vol 33 (5) ◽  
pp. 593-601 ◽  
Author(s):  
Louisa Ferrara ◽  
Ranjith Kamity ◽  
Shahidul Islam ◽  
Irene Sher ◽  
Dan Barlev ◽  
...  
Keyword(s):  
Pilot Study ◽  
Preterm Infants ◽  
Short Term ◽  
Pharyngeal Swallow ◽  
Short Term Effects

Upper esophageal sphincter impedance as a marker of sphincter opening diameter

2012 ◽  
Vol 302 (9) ◽  
pp. G909-G913 ◽  
Author(s):  
Taher I. Omari ◽  
Lara Ferris ◽  
Eddy Dejaeger ◽  
Jan Tack ◽  
Dirk Vanbeckevoort ◽  
...  
Keyword(s):  
Risk Index ◽  
Upper Esophageal Sphincter ◽  
Aim Analysis ◽  
Luminal Diameter ◽  
High Resolution Manometry ◽  
Swallowing Dysfunction ◽  
Pharyngeal Swallow ◽  
Esophageal Sphincter ◽  
Ues Opening ◽  
Swallow Function

The measurement of the physical extent of opening of the upper esophageal sphincter (UES) during bolus swallowing has to date relied on videofluoroscopy. Theoretically luminal impedance measured during bolus flow should be influenced by luminal diameter. In this study, we measured the UES nadir impedance (lowest value of impedance) during bolus swallowing and assessed it as a potential correlate of UES diameter that can be determined nonradiologically. In 40 patients with dysphagia, bolus swallowing of liquids, semisolids, and solids was recorded with manometry, impedance, and videofluoroscopy. During swallows, the UES opening diameter (in the lateral fluoroscopic view) was measured and compared with automated impedance manometry (AIM)-derived swallow function variables and UES nadir impedance as well as high-resolution manometry-derived UES relaxation pressure variables. Of all measured variables, UES nadir impedance was the most strongly correlated with UES opening diameter. Narrower diameter correlated with higher impedance ( r = −0.478, P < 0.001). Patients with <10 mm, 10–14 mm (normal), and ≥15 mm UES diameter had average UES nadir impedances of 498 ± 39 Ohms, 369 ± 31 Ohms, and 293 ± 17 Ohms, respectively (ANOVA P = 0.005). A higher swallow risk index, indicative of poor pharyngeal swallow function, was associated with narrower UES diameter and higher UES nadir impedance during swallowing. In contrast, UES relaxation pressure variables were not significantly altered in relation to UES diameter. We concluded that the UES nadir impedance correlates with opening diameter of the UES during bolus flow. This variable, when combined with other pharyngeal AIM analysis variables, may allow characterization of the pathophysiology of swallowing dysfunction.

Cineradiography in Closed and Open Pharyngeal Swallow

1988 ◽  
Vol 29 (4) ◽  
pp. 407-410 ◽  
Author(s):  
M. Birch-Iensen ◽  
P. S. Borgström ◽  
O. Ekberg
Keyword(s):  
Constrictor Muscle ◽  
Relative Incidence ◽  
Closed Type ◽  
Maximum Elevation ◽  
Asymptomatic Volunteers ◽  
Pharyngeal Swallow ◽  
Laryngeal Vestibule ◽  
Dysphagic Patients

The pattern of swallowing by which the oral bolus reaches an air-containing oropharynx is called an ‘open swallow’ whereas the sequence in which the oropharynx is collapsed on the arrival of the bolus is called a ‘closed swallow’. The significance of this distinction was further analyzed by a correlation with other laryngeal and pharyngeal functions during swallowing in a cineradiologic study in 75 dysphagic patients and 50 asymptomatic volunteers. The relative incidence of open and closed type swallows was similar in the two groups. The maximum elevation of the pharynx and larynx was the same in open and closed swallow, although in individuals with an open swallow the elevation occurred later than in individuals with a closed swallow. Epiglottic movement disturbances, defective closure of the laryngeal vestibule, pharyngeal constrictor muscle paresis, cricopharyngeal incoordination, cervical esophageal webs and Zenker diverticula were significantly more common in individuals with an open pharyngeal swallow than in those with closed swallowing.

scholarly journals Factors Influencing Initiation of Pharyngeal Swallow in Healthy Adults

2020 ◽  
Vol 29 (4) ◽  
pp. 1956-1964
Author(s):  
Ankita M. Bhutada ◽  
Rajarshi Dey ◽  
Bonnie Martin-Harris ◽  
Kendrea L. (Focht) Garand
Keyword(s):  
Healthy Adults ◽  
Barium Swallow ◽  
Large Variability ◽  
Modified Barium Swallow ◽  
Factors Influencing ◽  
Volume Viscosity ◽  
Pharyngeal Swallow ◽  
Swallow Study ◽  
Dysphagic Patients ◽  
Modified Barium Swallow Study

Purpose The purpose of this study was to investigate factors influencing the initiation of pharyngeal swallow (IPS) in healthy, nondysphagic adults. Method A total of 195 healthy participants ranging in age from 21 to 89 years participated in a modified barium swallow study. IPS was quantified using the Modified Barium Swallow Impairment Profile standardized scoring system across nine swallowing tasks observed in the lateral viewing plane for each participant. Results Large variability for bolus head location at time of hyoid burst (IPS) was observed within this healthy cohort, ranging from the ramus of the mandible to the pyriform sinuses. Significant effects of bolus volume, viscosity, sex, and race were also observed. Conclusion Study findings indicate that IPS is variable in healthy adults and influenced by volume, viscosity, sex, and race. Thus, variability in IPS may be considered typical in otherwise nondysphagic adults. The clinical significance of high Modified Barium Swallow Impairment Profile IPS scores in dysphagic patients, therefore, must be considered within the context of other swallowing impairments. Supplemental Material https://doi.org/10.23641/asha.12735935

scholarly journals Correction to: Volumetric Changes to the Pharynx in Healthy Aging: Consequence for Pharyngeal Swallow Mechanics and Function

Dysphagia ◽  
2020 ◽  
Vol 35 (6) ◽  
pp. 1008-1009
Author(s):  
Sonja M. Molfenter ◽  
Charles Lenell ◽  
Cathy L. Lazarus
Keyword(s):  
Healthy Aging ◽  
Pharyngeal Swallow ◽  
And Function
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