Pharyngeal Pressure Variability During Volitional Swallowing Maneuvers

Healthy Individuals ◽

Head Turn ◽

Pharyngeal Pressure ◽

Effortful Swallow ◽

Mendelsohn Maneuver ◽

Main Effect ◽

Esophageal Sphincter ◽

Swallowing Pressure ◽

Purpose: Within-individual pharyngeal swallowing pressure variability differs among pharyngeal regions in healthy individuals and increases with age. It remains unknown if pharyngeal pressure variability is impacted by volitional swallowing tasks. We hypothesized that pressure variability would increase during volitional swallowing maneuvers and differ among pharyngeal regions depending on the type of swallowing task being performed. Method: Pharyngeal high-resolution manometry was used to record swallowing pressure data from 156 healthy participants during liquid (5 cc) or saliva swallows, and during volitional swallowing tasks including effortful swallow, Mendelsohn maneuver, Masako maneuver, or during postural adjustments. The coefficient of variation was used to determine pressure variability of velopharynx, tongue base, hypopharynx, and upper esophageal sphincter regions. Repeated-measures analysis of variance was used on log-transformed data to examine effects of pharyngeal region and swallowing tasks on swallow-to-swallow variability. Results: There was a significant main effect of task with greater pressure variability for the effortful swallow ( p = .002), Mendelsohn maneuver ( p < .001), Masako maneuver ( p = .002), and the head turn ( p = .006) compared with normal effort swallowing. There was also a significant main effect of region ( p < .01). In general, swallowing pressure variability was lower for the tongue base and upper esophageal sphincter regions than the hypopharynx. There was no significant interaction of task and region (effortful, p = .182; Mendelsohn, p = .365; Masako, p = .885; chin tuck, p = .840; head turn, p = .059; and inverted, p = .773). Conclusions: Pharyngeal swallowing pressure variability increases in healthy individuals during volitional swallowing tasks. Less stable swallow patterns may result when tasks are less automatic and greater in complexity. These findings may have relevance to swallowing motor control integrity in healthy aging and individuals with neurogenic dysphagia.

Involvement of hypoglossal and recurrent laryngeal nerves on swallowing pressure

Journal of Applied Physiology ◽

10.1152/japplphysiol.00944.2017 ◽

2018 ◽

Vol 124 (5) ◽

pp. 1148-1154 ◽

Cited By ~ 10

Author(s):

Takanori Tsujimura ◽

Taku Suzuki ◽

Midori Yoshihara ◽

Shogo Sakai ◽

Naomi Koshi ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Hypoglossal Nerve ◽

Sensory Information ◽

Laryngeal Nerve ◽

Nerve Transection ◽

Swallowing Function ◽

Esophageal Sphincter ◽

Recurrent Laryngeal Nerves ◽

Swallowing Pressure

Swallowing pressure generation is important to ensure safe transport of an ingested bolus without aspiration or leaving residue in the pharynx. To clarify the mechanism, we measured swallowing pressure at the oropharynx (OP), upper esophageal sphincter (UES), and cervical esophagus (CE) using a specially designed manometric catheter in anesthetized rats. A swallow, evoked by punctate mechanical stimulation to the larynx, was identified by recording activation of the suprahyoid and thyrohyoid muscles using electromyography (EMG). Areas under the curve of the swallowing pressure at the OP, UES, and CE from two trials indicated high intrasubject reproducibility. Effects of transecting the hypoglossal nerve (12N) and recurrent laryngeal nerve (RLN) on swallowing were investigated. Following bilateral hypoglossal nerve transection (Bi-12Nx), OP pressure was significantly decreased, and time intervals between peaks of thyrohyoid EMG bursts and OP pressure were significantly shorter. Decreased OP pressure and shortened times between peaks of thyrohyoid EMG bursts and OP pressure following Bi-12Nx were significantly increased and longer, respectively, after covering the hard and soft palates with acrylic material. UES pressure was significantly decreased after bilateral RLN transection compared with that before transection. These results suggest that the 12N and RLN play crucial roles in OP and UES pressure during swallowing, respectively. We speculate that covering the palates with a palatal augmentation prosthesis may reverse the reduced swallowing pressure in patients with 12N or tongue damage by the changes of the sensory information and of the contact between the tongue and a palates. NEW & NOTEWORTHY Hypoglossal nerve transection reduced swallowing pressure at the oropharynx. Covering the hard and soft palates with acrylic material may reverse the reduced swallowing function caused by hypoglossal nerve damage. Recurrent laryngeal nerve transection reduced upper esophageal sphincter negative pressure during swallowing.

Pharyngeal swallowing mechanics associated with upper esophageal sphincter pressure wave

Head & Neck ◽

10.1002/hed.26029 ◽

2019 ◽

Vol 42 (3) ◽

pp. 467-475 ◽

Cited By ~ 3

Author(s):

Nelson H. May ◽

Kate W. Davidson ◽

William G. Pearson ◽

Ashli K. O'Rourke

Keyword(s):

Pressure Wave ◽

Sphincter Pressure ◽

Esophageal Sphincter ◽

S118 – Study of Pharyngeal Swallowing by High-resolution Manometry

Otolaryngology ◽

10.1016/j.otohns.2008.05.291 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P116-P117

Author(s):

Kenji Takasaki ◽

Umeki Hiroshi ◽

Kaori Enatsu ◽

Fujinobu Tanaka ◽

Hidetaka Kumagami ◽

...

Keyword(s):

High Resolution ◽

Normal Values ◽

Cervical Esophagus ◽

High Resolution Manometry ◽

Maximum Value ◽

Physiological Information ◽

Asymptomatic Adult ◽

Esophageal Sphincter ◽

Objectives This study aimed to demonstrate the feasibility of a novel high-resolution manometry (HRM) system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus. Methods 33 asymptomatic adult Japanese controls were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record pressures during swallowing from the velopharynx to the upper esophagus. The maximum values of the swallowing (dry and 5 ml of water) pressures at velo, meso-hypopharynx, and at the upper esophageal sphincter (UES) were measured. The resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure, and the distance from the nostril to the above-mentioned points of pressure were also measured. Results The maximum value of dry and water swallowing pressures at the velopharynx, meso-hypopharynx and UES, and the distances from the nasal vestibulum to each point were 132.3±61.3 (mmHg, mean ± standard deviation), and 146.5±77.5, 171.6±52.0, and 176.3±74.4, 163.5±70.6, and 239.3±80.1, and 9.8±1.2 (cm), and 9.8±1.3, 13.6±1.6, and 13.7±1.5, 17.0±1.9 and 17.1±1.6, respectively. The maximum value of the resting USE pressure, the length of the part in the cervical esophagus showing the resting USE pressure, and the distance from the nostril to the mid-point of the length of the resting UES pressure were 66.6±28.1 mmHg, 3.8±0.7 cm, and 18.2±1.6 cm, respectively. Conclusions The present study provides anatomical and physiological information about normal swallowing along the velopharynx and upper esophagus, which will be an aid to future clinical and investigative studies.

Effects of Head Rotation on Pharyngeal Function during Normal Swallow

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949810700414 ◽

1998 ◽

Vol 107 (4) ◽

pp. 344-348 ◽

Cited By ~ 55

Author(s):

Yukio Ohmae ◽

Masami Ogura ◽

Satoshi Kitahara ◽

Takehiro Karaho ◽

Tetsuzo Inouye

Keyword(s):

Healthy Subjects ◽

Head Rotation ◽

Normal Subjects ◽

Resting Pressure ◽

Esophageal Sphincter ◽

Pharyngeal Clearance ◽

Pharyngeal Swallowing ◽

Peak Pressures ◽

Pharyngeal Function

This study quantified the effects of head rotation on pharyngeal swallowing in healthy subjects. Videofluoroscopic and oropharyngeal manometric examinations of pharyngeal swallowing were performed on seven volunteers with the head in neutral and rotated positions. Videofluoroscopic study revealed that head rotation swallow causes the bolus to lateralize away from the direction of head rotation. Pharyngeal manometric study indicated that the pharyngeal peak pressures toward the side of head rotation were significantly increased, whereas the pharyngeal pressures opposite the side of head rotation were not affected. Head rotation swallow produced a significant fall in upper esophageal sphincter (UES) resting pressure and a delay in UES closing. We concluded that the head rotation swallow in normal subjects not only alters the bolus pathway, but also has a useful effect on both pharyngeal clearance and UES dynamics.

Predicting the activation states of the muscles governing upper esophageal sphincter relaxation and opening

10.1152/ajpgi.00388.2015 ◽

2016 ◽

Vol 310 (6) ◽

pp. G359-G366 ◽

Cited By ~ 12

Author(s):

Taher I. Omari ◽

Corinne A. Jones ◽

Michael J. Hammer ◽

Charles Cock ◽

Philip Dinning ◽

...

Keyword(s):

Sensory Information ◽

Intraluminal Pressure ◽

Emg Activity ◽

Motor Behaviors ◽

Pharyngeal Pressure ◽

Intraluminal Impedance ◽

Esophageal Sphincter ◽

Ues Opening ◽

Swallowing Muscles

The swallowing muscles that influence upper esophageal sphincter (UES) opening are centrally controlled and modulated by sensory information. Activation and deactivation of neural inputs to these muscles, including the intrinsic cricopharyngeus (CP) and extrinsic submental (SM) muscles, results in their mechanical activation or deactivation, which changes the diameter of the lumen, alters the intraluminal pressure, and ultimately reduces or promotes flow of content. By measuring the changes in diameter, using intraluminal impedance, and the concurrent changes in intraluminal pressure, it is possible to determine when the muscles are passively or actively relaxing or contracting. From these “mechanical states” of the muscle, the neural inputs driving the specific motor behaviors of the UES can be inferred. In this study we compared predictions of UES mechanical states directly with the activity measured by electromyography (EMG). In eight subjects, pharyngeal pressure and impedance were recorded in parallel with CP- and SM-EMG activity. UES pressure and impedance swallow profiles correlated with the CP-EMG and SM-EMG recordings, respectively. Eight UES muscle states were determined by using the gradient of pressure and impedance with respect to time. Guided by the level and gradient change of EMG activity, mechanical states successfully predicted the activity of the CP muscle and SM muscle independently. Mechanical state predictions revealed patterns consistent with the known neural inputs activating the different muscles during swallowing. Derivation of “activation state” maps may allow better physiological and pathophysiological interpretations of UES function.

Influence of normal aging on oral-pharyngeal and upper esophageal sphincter function during swallowing

10.1152/ajpgi.1995.268.3.g389 ◽

1995 ◽

Vol 268 (3) ◽

pp. G389-G396 ◽

Cited By ~ 24

Author(s):

D. W. Shaw ◽

I. J. Cook ◽

M. Gabb ◽

R. H. Holloway ◽

M. E. Simula ◽

...

Keyword(s):

The Elderly ◽

Normal Aging ◽

Flow Rates ◽

Elderly Individuals ◽

Sphincter Function ◽

Pharyngeal Swallow ◽

Esophageal Sphincter ◽

Ues Opening ◽

The influence of aging on oral-pharyngeal swallowing was assessed by simultaneous manometry and videoradiography in 14 nondysphagic elderly individuals (mean age 76 yr) and 11 healthy, young controls (mean age 21 yr). Sphincter opening was diminished significantly in the elderly (P = 0.0001), but trans-sphincteric bolus flow rates were preserved. The increased impedance to trans-sphincteric bolus flow from reduced sphincter opening in the aged was reflected in a significant increase in hypopharyngeal intrabolus pressure (P = 0.003). Oral transit time was significantly prolonged in the aged (P = 0.01). The timing of upper esophageal sphincter (UES) manometric relaxation and of opening was significantly delayed in the aged (P = 0.0001), and this delay was comparable in magnitude to the prolongation in oral transit. Coordination of UES relaxation and opening with midpharyngeal contraction was not significantly affected by age. Deglutitive hyolaryngeal motion was not affected by age but was delayed by a duration equivalent to the prolongation in oral transit. We conclude that normal aging prolongs the oral-pharyngeal swallow that impairs UES opening but does not influence pharyngo-sphincteric coordination.

AGE-RELATED FUNCTIONAL RESERVE DECLINE IS NOT SEEN IN PHARYNGEAL SWALLOWING PRESSURES

Innovation in Aging ◽

10.1093/geroni/igz038.613 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S172-S172

Author(s):

Corinne A Jones ◽

Melanie Looper ◽

Timothy McCulloch

Keyword(s):

Repeated Measures ◽

Tongue Pressure ◽

Older Individuals ◽

Functional Reserve ◽

Muscle Properties ◽

High Resolution Manometry ◽

Pharyngeal Pressure ◽

Age Related ◽

Abstract Age-related decline in functional reserve has been described in tongue strength: tongue pressure during swallowing does not change with age, but maximal-effort isometric tongue pressure decreases with age. Healthy persons show a slight increase in pharyngeal swallowing pressure with age, but it is unknown if there is a similar decline in functional reserve. Fifty-six healthy adults (n=38 60 years) underwent pharyngeal high-resolution manometry during effortful and normal-effort thin liquid swallows. Repeated measures ANOVAs were performed on maximum pressures, pharyngeal contractile integral (PCI), pharyngeal pressure gradients, and upper esophageal sphincter minimum pressures. We hypothesized that older individuals would generate a less-robust pressure increase with effortful swallowing than younger individuals. Maximum pressures, PCI, and gradients increase during effortful swallowing (p<0.001), but there was no interaction effect with age, suggesting a lack of age-related functional reserve decline. Older individuals had greater UES minimum pressures than younger individuals in the effortful swallowing task (p=0.03), which may stem from reduced muscular compliance in this area. These findings do not align with those reported in tongue pressures, suggesting that muscle properties and pressure generation may be fundamentally different between the pharynx and the oral tongue. Alternatively, the effortful swallowing task may not elicit maximum contractility of the pharyngeal musculature. The preserved ability to increase pharyngeal pressure during effortful swallowing may support the use of the effortful swallow exercise in older adults with swallowing disorders.

Effect of Tongue-Hold Swallow on Pharyngeal Contractile Properties in Healthy Individuals

Dysphagia ◽

10.1007/s00455-020-10217-9 ◽

2021 ◽

Author(s):

Yoichiro Aoyagi ◽

Miho Ohashi ◽

Shiori Ando ◽

Yoko Inamoto ◽

Keiko Aihara ◽

...

Keyword(s):

Peak Pressure ◽

Contractile Properties ◽

Healthy Individuals ◽

Anterior Portion ◽

High Resolution Manometry ◽

Biomechanical Changes ◽

Esophageal Sphincter ◽

Bolus Propulsion ◽

Healthy Participants

AbstractTongue-hold swallow (THS) is a swallow exercise in which an individual swallows saliva while holding the anterior portion of the tongue between the front teeth. The effect of THS on pharyngeal contractile vigor is still unclear. The purpose of this study was to quantify THS using high-resolution manometry with a contractile integral analysis. Twenty-two healthy participants performed three different saliva swallow tasks: normal swallow, weak THS (in which the tongue was protruded 1 cm outside the upper incisors), and strong THS (in which the tongue was protruded 2 cm outside the upper incisors). The participants repeated each task twice randomly. Pharyngeal and upper esophageal sphincter metrics, including the pharyngeal contractile integral, were analyzed. Both weak and strong THS enhanced the velopharyngeal contractile integral and peak pressure compared with normal swallow (P < 0.01). THS also prolonged mesopharyngeal contraction (P < 0.01). Holding the tongue anteriorly during swallow requires significant biomechanical changes to pharyngeal contractile properties at the superior and middle pharyngeal constrictor levels; thus, it may serve as a resistance exercise for the muscles that are involved in bolus propulsion.

Volitional augmentation of upper esophageal sphincter opening during swallowing

10.1152/ajpgi.1991.260.3.g450 ◽

1991 ◽

Vol 260 (3) ◽

pp. G450-G456 ◽

Cited By ~ 19

Author(s):

P. J. Kahrilas ◽

J. A. Logemann ◽

C. Krugler ◽

E. Flanagan

Keyword(s):

Normal Subjects ◽

Biomechanical Analysis ◽

Intraluminal Pressure ◽

Mendelsohn Maneuver ◽

Before And After ◽

Esophageal Sphincter ◽

Ues Opening

Studies were done on eight normal subjects with synchronized videofluoroscopy and manometry to facilitate a biomechanical analysis of the extent and mechanism of voluntary augmentation of upper esophageal sphincter (UES) opening during swallowing. Movements of the hyoid and larynx, dimensions of sphincter opening, and intraluminal pressure events were determined at 1/30-s intervals during swallows of 1 and 10 ml of liquid barium. Swallows of each volume were obtained both before and after subjects were taught a maneuver designed to augment UES opening, the Mendelsohn maneuver (voluntary prolongation of laryngeal excursion at the midpoint of the swallow). At either volume, use of the maneuver increased the duration of the anterior-superior excursion of the larynx and hyoid and consequently delayed sphincter closure by maintaining traction on the anterior sphincter wall. The onset of the pharyngeal contraction (the event normally culminating in sphincter closure) was not affected by the maneuver. We conclude that swallow-related hyoid motion, laryngeal motion, and UES opening are subject to volitional augmentation, supporting the notion that biofeedback techniques can be used to modify impaired swallowing.

Physiology of esophageal sensorimotor malfunctions in neonatal neurological illness

10.1152/ajpgi.00404.2012 ◽

2013 ◽

Vol 304 (6) ◽

pp. G574-G582 ◽

Cited By ~ 2

Author(s):

Sudarshan R. Jadcherla ◽

Chin Yee Chan ◽

Rebecca Moore ◽

Soledad Fernandez ◽

Reza Shaker

Keyword(s):

Liquid Volume ◽

Esophageal Clearance ◽

Afferent Activation ◽

Postmenstrual Age ◽

The Media ◽

Esophageal Sphincter ◽

Secondary Peristalsis ◽

Pharyngeal Swallowing ◽

And Control

We aimed to define the sensorimotor characteristics of aero-digestive reflexes evoked upon midesophageal provocations in neuropathology infants. Provocative esophageal motility testing was performed in 20 neuropathology infants and 10 controls at 42.3 ± 0.6 and 38.9 ± 0.9 wk postmenstrual age. Data from 1,073 infusions were examined for the sensory thresholds, response frequencies, response magnitude of upper esophageal sphincter (UES) contractile reflexes, lower esophageal sphincter (LES) relaxation reflexes, and peristaltic reflexes using mixed statistical models. Threshold volumes for air and liquid in neuropathology and control infants were similar for all reflexes. Graded air- and liquid volume-dependent UES contractile reflex, LES relaxation reflex, and peristaltic reflex frequency recruitment were present in neuropathology and control subjects for the media ( P < 0.0001) and the reflexes ( P < 0.0001). In neuropathology infants (vs. controls), UES contractile magnitude is higher ( P < 0.0001); LES relaxation reflex occurred earlier ( P = 0.008); LES nadir duration lasted longer ( P = 0.006); secondary peristalsis is the chief method of esophageal clearance ( P < 0.0001); pharyngeal swallows and deglutition apneas are less frequent ( P = 0.001); proximal, midesophageal waveform magnitudes and duration are exaggerated ( P < 0.008). UES contractile reflex was longer with liquid than air in both groups ( P = 0.03). We concluded that 1) perception to midesophageal provocation remains preserved in neuropathology neonates; 2) sustained and exaggerated myogenic response from afferent activation is evident by increased excitatory efferent outputs to the UES and esophageal body and increased inhibitory efferent outputs to the LES; 3) dysfunctional regulation of pharyngeal swallowing and infrequent deglutition responses indicate the possibility of impaired descending modulation and central malfunctions of brainstem and vagal nuclei.