Biomechanics of failed deglutitive upper esophageal sphincter relaxation in neurogenic dysphagia

2002 ◽  
Vol 283 (1) ◽  
pp. G16-G26 ◽  
Author(s):  
Rohan B. H. Williams ◽  
Karen L. Wallace ◽  
Galib N. Ali ◽  
Ian J. Cook
Keyword(s):  
Biomechanical Properties ◽  
Upper Esophageal Sphincter ◽  
Zenker’S Diverticulum ◽  
Bolus Volume ◽  
Neurogenic Dysphagia ◽  
Zenker's Diverticulum ◽  
Pharyngeal Swallow ◽  
Extrapyramidal Disease ◽  
Esophageal Sphincter ◽  
Ues Opening

Our aims were to examine the etiology and biomechanical properties of the nonrelaxing upper esophageal sphincter (UES) and the relationship between UES opening and failed relaxation. We examined the relationships among swallowed bolus volume, intrabolus pressure, sagittal UES diameter, the pharyngeal swallow response, and geniohyoid shortening in 18 patients with failed UES relaxation, 23 healthy aged controls, and 15 with Zenker's diverticulum. Etiology of failed UES relaxation was 56% medullary disease, 33% Parkinson's or extrapyramidal disease; and 11% idiopathic. Extent of UES opening ranged from absent to normal and correlated with preservation of the pharyngeal swallow response ( P = 0.012) and geniohyoid shortening ( P = 0.046). Intrabolus pressure was significantly greater compared with aged controls ( P < 0.001) or Zenker's diverticulum ( P < 0.001). The bolus volume-dependent increase in intrabolus pressure evident in controls was not observed in failed UES relaxation. The nonrelaxing UES therefore displays a constant loss of sphincter compliance throughout the full, and potentially normal, range of expansion during opening. Adequacy of UES opening is influenced by the degree of preservation of the pharyngeal swallow response and hyolaryngeal traction. In contrast, the stenotic UES displays a static loss of compliance, only apparent once the limit of sphincter expansion is reached.

Upper esophageal sphincter function in patients with Zenker's diverticulum

Dysphagia ◽  
1988 ◽  
Vol 3 (2) ◽  
pp. 90-92 ◽  
Author(s):  
T. Frieling ◽  
W. Berges ◽  
H. J. Lübke ◽  
P. Enck ◽  
M. Wienbeck
Keyword(s):  
Upper Esophageal Sphincter ◽  
Zenker’S Diverticulum ◽  
Sphincter Function ◽  
Zenker's Diverticulum ◽  
Esophageal Sphincter

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.

Pharyngeal (Zenker's) diverticulum is a disorder of upper esophageal sphincter opening

1992 ◽  
Vol 103 (4) ◽  
pp. 1229-1235 ◽  
Author(s):  
Ian J. Cook ◽  
Mary Gabb ◽  
Voula Panagopoulos ◽  
Glyn G. Jamieson ◽  
Wylie J. Dodds ◽  
...  
Keyword(s):  
Upper Esophageal Sphincter ◽  
Zenker’S Diverticulum ◽  
Zenker's Diverticulum ◽  
Esophageal Sphincter

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

1995 ◽  
Vol 268 (3) ◽  
pp. G389-G396 ◽  
Author(s):  
D. W. Shaw ◽  
I. J. Cook ◽  
M. Gabb ◽  
R. H. Holloway ◽  
M. E. Simula ◽  
...  
Keyword(s):  
The Elderly ◽  
Normal Aging ◽  
Upper Esophageal Sphincter ◽  
Flow Rates ◽  
Elderly Individuals ◽  
Sphincter Function ◽  
Pharyngeal Swallow ◽  
Esophageal Sphincter ◽  
Ues Opening ◽  
Pharyngeal Swallowing

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.

Opening mechanisms of the human upper esophageal sphincter

1989 ◽  
Vol 257 (5) ◽  
pp. G748-G759 ◽  
Author(s):  
I. J. Cook ◽  
W. J. Dodds ◽  
R. O. Dantas ◽  
B. Massey ◽  
M. K. Kern ◽  
...  
Keyword(s):  
Normal Subjects ◽  
Upper Esophageal Sphincter ◽  
Feedback Mechanism ◽  
Bolus Volume ◽  
Cross Sectional ◽  
Early Entry ◽  
Hyoid Movement ◽  
Esophageal Sphincter ◽  
Ues Opening ◽  
High Pressure Zone

Our goals in this study were to evaluate the mechanisms operative in swallow-associated opening of the upper esophageal sphincter (UES) and to determine the dynamics of fluid flow across the sphincter. For this purpose, we obtained concurrent videofluorographic and manometric studies of 2- to 30-ml barium swallows in 15 normal subjects. We found that the resting UES high-pressure zone corresponded closely with the location of the cricopharyngeus. The findings indicated that manometric UES relaxation and anterior hyoid traction on the larynx invariably preceded UES opening. With graded increases in bolus volume, progressive increases occurred in UES diameter, cross-sectional area, flow duration, and transsphincteric flow rate. Intrabolus pressure upstream to the UES and within the UES at its opening during transsphincteric flow of barium remained within a narrow physiological range of less than 10 mmHg up to a bolus volume of 10 ml. With increases in bolus volume, anterior hyoid movement, UES relaxation, and UES opening occurred sooner in the swallow sequence to accommodate the early entry of large boluses into the pharynx. We conclude that during swallowing 1) normal UES opening involves sphincter relaxation, anterior laryngeal traction, and intrabolus pressure, 2) volume-dependent adaptive changes in UES dimension accommodate large bolus volumes and flow rates with minimal requirement for increases in upstream, or intrasphincteric, intrabolus pressure or UES opening duration, and 3) volume-dependent changes in UES dimensions as well as timing of UES relaxation and opening indicate a sensory feedback mechanism that modulates some components of the swallow response generated by the brain stem swallow centers.

Intrabolus pressure gradient identifies pathological constriction in the upper esophageal sphincter during flow

2003 ◽  
Vol 285 (5) ◽  
pp. G1037-G1048 ◽  
Author(s):  
Anupam Pal ◽  
Rohan B. Williams ◽  
Ian J. Cook ◽  
James G. Brasseur
Keyword(s):  
Pressure Gradient ◽  
Patient Group ◽  
Frictional Resistance ◽  
Upper Esophageal Sphincter ◽  
Space Time ◽  
Time Patterns ◽  
Space Time Structure ◽  
Pharyngeal Swallow ◽  
Esophageal Sphincter ◽  
Ues Opening

Propulsion of a bolus through the upper esophageal sphincter (UES) is driven by a pressure drop in the direction of flow against frictional resisting force. Basic mechanics suggest that the axial rate of drop in intrabolus pressure (IBP), i.e., the intrabolus pressure gradient (IBPG), should be locally sensitive to abnormal constriction. We sought to quantify space-time patterns of IBP and IBPG that correlate with pathological disruption to transsphincteric bolus transport. High-resolution high-fidelity perfused manometry was applied concurrent with videofluoroscopy in 6 healthy controls and 10 patients with restricted UES opening and 4 bolus volumes. Pressures were interpolated spatially and displayed as space-time isocontours with bolus head and tail trajectories superimposed to identify the IBP domain. IBP and IBPG were averaged over an approximately steady period of transsphincteric flow. The axial location and magnitude of maximum IBPG were quantified for each swallow relative to the location of the abnormal restriction. We found that average hypopharyngeal IBP and locally maximal IBPG were significantly higher in the patient group ( P < 0.001), whereas the maximum IBPG was insensitive to bolus volume, and the locations of maximum IBPG in the patient group were well correlated with axial locations of maximal UES constriction ( r = 0.84, P < 0.01). Space-time structure of IBP and IBPG correlated qualitatively with swallow dysfunction. Because IBPG reflects pressure force driving the bolus against frictional force in the UES, IBPG reflects local changes in frictional resistance from pathological constriction during bolus flow. Consequently, the location and magnitude of IBPG reflect the existence and location of abnormal constriction, and IBP and IBPG structure reflect decompensation of the pharyngeal swallow.

Biochemical Markers of Upper Esophageal Sphincter Compliance in Patients with Zenker's Diverticulum

1997 ◽  
Vol 70 (1) ◽  
pp. 46-48 ◽  
Author(s):  
Marco Venturi ◽  
Luigi Bonavina ◽  
Laura Colombo ◽  
Laura Antoniazzi ◽  
Alessandra Bruno ◽  
...  
Keyword(s):  
Biochemical Markers ◽  
Upper Esophageal Sphincter ◽  
Zenker’S Diverticulum ◽  
Zenker's Diverticulum ◽  
Esophageal Sphincter

Disorders Involving the Pharynx and Upper Esophagus

2016 ◽  
Author(s):  
Hiroshi Mashimo
Keyword(s):  
Viral Infections ◽  
Oropharyngeal Dysphagia ◽  
Neuromuscular Control ◽  
Upper Esophageal Sphincter ◽  
Peritonsillar Abscess ◽  
Zenker’S Diverticulum ◽  
Zenker's Diverticulum ◽  
Globus Pharyngeus ◽  
Submental Muscles ◽  
Esophageal Sphincter

A wide variety of disorders can affect the pharynx and upper esophagus, such as inherited or acquired structural abnormalities, malignancies, and inflammation secondary to a number of etiologies including bacterial, yeast and viral infections, irradiation, and gastroesophageal reflux disorder. Laryngoceles and peritonsillar abscess can also lead to pain and dysfunction. However, this review will focus on the main motility disorders that affect the pharynx and upper esophagus, namely oropharyngeal dysphagia, disorders associated with globus pharyngeus, and Zenker’s diverticulum. Figures show the anatomy of the three stages of normal swallow, various findings on functional endoscopic evaluation of swallowing, electromyography of the cricopharyngeal sphincter and submental muscles, and Zenker’s diverticulum. Tables list causes of oropharyngeal dysphagia, neuromuscular control of the pharyngeal phase (with identified cranial and cervical spinal nerve roots), pathophysiology of oropharyngeal dysplasia, diagnostic tests for oropharyngeal dysplasia, behavioral treatments to improve swallow and reduce aspiration, and potential overlapping causes of impaired upper esophageal sphincter relaxation.   This review contains 4 highly rendered figures, 6 tables, and 40 references   Key words: Oropharyngeal dysphagia; Globus; Upper esophageal sphincter dysfunction; Swallowing disorder; Dysphagia; Zenker’s diverticulum; Swallow assessment; Globus pharyngeus

scholarly journals The Effect of Bolus Volume on Hyoid Kinematics in Healthy Swallowing

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Ahmed Nagy ◽  
Sonja M. Molfenter ◽  
Melanie Péladeau-Pigeon ◽  
Shauna Stokely ◽  
Catriona M. Steele
Keyword(s):  
Peak Velocity ◽  
Upper Esophageal Sphincter ◽  
Healthy Population ◽  
Bolus Volume ◽  
Velocity Increase ◽  
Movement Distance ◽  
Hyoid Movement ◽  
Laryngeal Vestibule ◽  
Esophageal Sphincter ◽  
Liquid Bolus

Hyoid movement in swallowing is biomechanically linked to closure of the laryngeal vestibule for airway protection and to opening of the upper esophageal sphincter. Studies suggest that the range of hyoid movement is highly variable in the healthy population. However, other aspects of hyoid movement such as velocity remain relatively unexplored. In this study, we analyze data from a sample of 20 healthy young participants (10 male) to determine whether hyoid movement distance, duration, velocity, and peak velocity vary systematically with increases in thin liquid bolus volume from 5 to 20 mL. The temporal correspondence between peak hyoid velocity and laryngeal vestibule closure was also examined. The results show that maximum hyoid position and peak velocity increase significantly for 20 mL bolus volumes compared to smaller volumes, and that the timing of peak velocity is closely linked to achieving laryngeal vestibule closure. This suggests that generating hyoid movements with increased power is a strategy for handling larger volumes.

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.

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