Mechanism and timing of nasopharyngeal closure during swallowing and belching

1995 ◽  
Vol 268 (6) ◽  
pp. G1037-G1042 ◽  
Author(s):  
K. Dua ◽  
R. Shaker ◽  
J. Ren ◽  
R. Arndorfer ◽  
C. Hofmann
Keyword(s):  
Healthy Volunteers ◽  
Soft Palate ◽  
Temporal Relationship ◽  
Upper Esophageal Sphincter ◽  
Pharyngeal Muscle ◽  
Constrictor Muscle ◽  
Complete Closure ◽  
Esophageal Sphincter ◽  
Manometric Technique ◽  
Technique Analysis

The mechanism(s) of nasopharyngeal closure (NPC) and its temporal relationship with other biomechanical events during swallowing and belching were studied in seven healthy volunteers, aged 26-39 yr, by concurrent videoendoscopic, videofluoroscopic, and manometric technique. Analysis of the videoendoscopic recordings showed that deglutitive NPC consisted of elevation of the soft palate and adduction of the superior pharyngeal constrictor muscle. Videofluoroscopy identified only the palatal elevation clearly. During belching, however, only palatal elevation occurred. Deglutitive NPC ranged between 0.73 and 0.94 s (0.8 +/- 0.04 SE), with a tendency to be longer with larger swallowed volumes. Onset of NPC was identified earlier endoscopically than as seen fluoroscopically. Complete NPC preceded the arrival of barium bolus into the pharynx, and this pattern was seen for all volumes tested. Manometric onset of upper esophageal sphincter (UES) relaxation was seen before the onset of NPC, but the physical opening of the UES as seen fluoroscopically occurred after complete closure of the nasopharynx. We conclude the following: 1) The mechanism of NPC during swallowing and belching is different. During swallowing, NPC has two tiers of closure, palatal elevation and superior pharyngeal muscle adduction; during belching only palatal elevation occurs. 2) NPC is tightly coordinated with other biomechanical events during swallowing and belching.

Functional Assessment of the Pharynx at Rest and during Swallowing in Partially Paralyzed Humans 

1997 ◽  
Vol 87 (5) ◽  
pp. 1035-1043 ◽  
Author(s):  
Lars I. Eriksson ◽  
Eva Sundman ◽  
Rolf Olsson ◽  
Lena Nilsson ◽  
Hanne Witt ◽  
...  
Keyword(s):  
Muscle Function ◽  
Upper Esophageal Sphincter ◽  
Adductor Pollicis ◽  
Sphincter Muscle ◽  
Muscle Coordination ◽  
Bolus Transit ◽  
Constrictor Muscle ◽  
Esophageal Sphincter ◽  
Resting Tone ◽  
Pharyngeal Function

Background Functional characteristics of the pharynx and upper esophagus, including aspiration episodes, were investigated in 14 awake volunteers during various levels of partial neuromuscular block. Pharyngeal function was evaluated using videoradiography and computerized pharyngeal manometry during contrast bolus swallowing. Methods Measurements of pharyngeal constrictor muscle function (contraction amplitude, duration, and slope), upper esophageal sphincter muscle resting tone, muscle coordination, bolus transit time, and aspiration under fluoroscopic control (laryngeal or tracheal penetration) were made before (control measurements) and during a vecuronium-induced partial neuromuscular paralysis, at fixed intervals of mechanical adductor pollicis muscle train-of-four (TOF) fade; that is, at TOF ratios of 0.60, 0.70, 0.80, and after recovery to a TOF ratio > 0.90. Results Six volunteers aspirated (laryngeal penetration) at a TOF ratio < 0.90. None of them aspirated at a TOF ratio > 0.90 or during control recording. Pharyngeal constrictor muscle function was not affected at any level of paralysis. The upper esophageal sphincter resting tone was significantly reduced at TOF ratios of 0.60, 0.70, and 0.80 (P < 0.05). This was associated with reduced muscle coordination and shortened bolus transit time at a TOF ratio of 0.60. Conclusions Vecuronium-induced partial paralysis cause pharyngeal dysfunction and increased risk for aspiration at mechanical adductor pollicis TOF ratios < 0.90. Pharyngeal function is not normalized until an adductor pollicis TOF ratio of > 0.90 is reached. The upper esophageal sphincter muscle is more sensitive to vecuronium than is the pharyngeal constrictor muscle.

Cricopharyngeal Dysfunction

1992 ◽  
Vol 106 (2) ◽  
pp. 163-168 ◽  
Author(s):  
Janet A. Wilson ◽  
Anne Pryde ◽  
Paul L. Allan ◽  
Arnold G.D. Maran
Keyword(s):  
Healthy Volunteers ◽  
Upper Esophageal Sphincter ◽  
Control Group ◽  
Muscular Hypertrophy ◽  
Cricopharyngeal Myotomy ◽  
Esophageal Sphincter ◽  
Cricopharyngeal Dysfunction ◽  
Ues Opening ◽  
Dysphagic Patients ◽  
Radiologic Evidence

The aim of the study was to determine the manometric patterns in dysphagic patients with radiologic evidence of upper esophageal sphincter (UES) dysfunction. Nineteen patients with radiographic abnormalities of the UES underwent measurement of several parameters of UES tonic pressure and pharyngoesophageal water swallow dynamics. At least two UES tonic pressures were elevated in six subjects, compared with a control group of 67 healthy volunteers. No patient had UES achalasia. The cricopharyngeal impression in the remaining patients may represent muscular hypertrophy or deficiency of UES opening, despite manometric relaxation, but its relationship to the patient's symptoms remains unknown. Cricopharyngeal myotomy appears to be a reasonable treatment for patients with manometric UES hypertonicity.

Function of upper esophageal sphincter during swallowing: the grabbing effect

1997 ◽  
Vol 272 (5) ◽  
pp. G1057-G1063
Author(s):  
P. Pouderoux ◽  
P. J. Kahrilas
Keyword(s):  
Healthy Volunteers ◽  
Axial Force ◽  
Traction Force ◽  
Force Transducer ◽  
Upper Esophageal Sphincter ◽  
Cervical Esophagus ◽  
Sphere Diameter ◽  
Laryngeal Inlet ◽  
Pharyngeal Swallow ◽  
Esophageal Sphincter

This study investigated deglutitive axial force developed within the pharynx, upper esophageal sphincter (UES), and cervical esophagus. Position and deglutitive excursion of the UES were determined using combined manometry and videofluoroscopy in eight healthy volunteers. Deglutitive clearing force was quantified with a force transducer to which nylon balls of 6- or 8-mm diameter were tethered and positioned within the oropharynx, hypopharynx, UES, and cervical esophagus. Axial force recordings were synchronized with videofluoroscopic imaging. Clearing force was dependent on both sphere diameter (P < 0.05) and location, with greater force exhibited in the hypopharynx and UES compared with the oropharynx and esophagus (P < 0.05). Within the UES, the onset of traction force coincided with passage of the pharyngeal clearing wave but persisted well beyond this. On videofluoroscopy, the persistent force was associated with the aboral motion of the ball caught within the UES. Force abated with gradual slippage of the UES around the ball. The force attributable to the combination of UES contraction and laryngeal descent was named the grabbing effect. The grabbing effect functions to transfer luminal contents distal to the laryngeal inlet at the end of the pharyngeal swallow, presumably acting to prevent regurgitation and/or aspiration of swallowed material.

scholarly journals Enhancing Visibility of the Hypopharyngeal-Esophageal Region by Introduction of a Physiological Eructation Maneuver

2019 ◽  
Vol 4 (1) ◽  
pp. 1-6
Author(s):  
Svetlana Politz ◽  
Martin Wagner ◽  
Degenhart Schwub ◽  
Sandra Cattenberg ◽  
Robert Thurnheer ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Physiological Function ◽  
Upper Esophageal Sphincter ◽  
Medical Examination ◽  
Transnasal Endoscopy ◽  
Complementary Method ◽  
Flexible Laryngoscopy ◽  
Offline Analysis ◽  
Esophageal Sphincter ◽  
Cold Drink

Background: In routine medical examination, the hypopharyngeal-esophageal area (HER) is difficult to assess due to its position and anatomical complexity. The purpose of this study was to evaluate the feasibility of a volitional eructation maneuver during transnasal flexible laryngoscopy and its influence on the visibility of the HER. Methods: Twenty healthy volunteers underwent flexible laryngoscopy. Once the larynx was freely visible during laryngoscopy, the subjects were asked to trigger a “burp.” The volitional belching during the study was assisted by drinking a carbonated cold drink. The triggered relaxation of the upper esophageal sphincter along with the widening of the hypopharynx region was recorded and subsequently analyzed frame by frame. Results: Out of 20 volunteers, 16 (80%) were able to volitionally induce an eructation. Significant widening of the hypopharynx region up to the relaxant upper esophageal sphincter could be recorded. The structures were clearly visible in the offline analysis. In 13 (81%) of the 16 subjects who could induce an eructation, the upper esophageal sphincter was partially visible or free for full inspection. Conclusion: The eructation method as a simple physiological function can be used as a complementary method during flexible transnasal endoscopy to enhance visibility of the entire hypopharynx region as well as the upper esophageal sphincter.

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

1997 ◽  
Vol 273 (5) ◽  
pp. G1071-G1076 ◽  
Author(s):  
G. N. Ali ◽  
I. J. Cook ◽  
T. M. Laundl ◽  
K. L. Wallace ◽  
D. J. De Carle
Keyword(s):  
Healthy Volunteers ◽  
Upper Esophageal Sphincter ◽  
Bolus Volume ◽  
Potential Influence ◽  
Transit Times ◽  
Esophageal Sphincter

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 midpharyngeal 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.

Optimal Stimulus Intensity and Reliability of Air Stimulation Technique for Elicitation of Laryngo-Upper Esophageal Sphincter Contractile Reflex

2005 ◽  
Vol 114 (3) ◽  
pp. 223-228 ◽  
Author(s):  
Osamu Kawamura ◽  
Caryn Easterling ◽  
Candy Hofmann ◽  
Tanya Rittmann ◽  
Reza Shaker
Keyword(s):  
Healthy Volunteers ◽  
Stimulus Intensity ◽  
Upper Esophageal Sphincter ◽  
Abrupt Increase ◽  
Esophageal Sphincter ◽  
Stimulation Technique

To determine the optimal air stimulus intensity and duration for elicitation of the laryngo–upper esophageal sphincter (UES) contractile reflex, we studied 37 healthy volunteers 20 to 81 years of age. A sleeve device monitored the UES pressure. For laryngeal stimulation, we used an air stimulator unit (Pentax AP-4000) that incorporated a nasolaryngeal endoscope. The arytenoids and interarytenoid areas were stimulated at least three times by three different stimuli: 6–mm Hg air pulse with 50-ms duration, 10–mm Hg air pulse with 50-ms duration, and 6–mm Hg air pulse with 2-second duration. Of 1,165 air stimulations, 1,041 resulted in mucosal deflections. Of these, 451 resulted in an abrupt increase in UES pressure. The response/deflection ratio for 6–mm Hg stimulation with 2-second duration was significantly higher than those for air pulses with 50-ms duration (p < .001). We conclude that although the laryngo-UES contractile reflex can be elicited by an air pulse with 50-ms duration, this ultrashort stimulation is not reliable. Using longer-duration pulses (at least 2 seconds) improves the reliability of elicitation of the laryngo-UES contractile reflex.

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