Article

Pharyngeal Swallow Adaptations to Bolus Volume Measured with High-Resolution Manometry

Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
The Laryngoscope (Impact Factor: 2.03). 12/2010; 120(12):2367-73. DOI: 10.1002/lary.21150
Source: PubMed

ABSTRACT : To determine the effect of bolus volume on pharyngeal swallowing using high-resolution manometry (HRM).
: Repeated measures with subjects serving as own controls.
: Twelve subjects swallowed four bolus volumes in the neutral head position: saliva; 5 mL water; 10 mL water; and 20 mL water. Pressure measurements were taken along the length of the pharynx using a high-resolution manometer, with emphasis placed on the velopharynx, tongue base, and upper esophageal sphincter (UES). Variables were analyzed across bolus volumes using three-way repeated measures analysis of covariance (ANCOVA) investigating the effect of sex, bolus volume, and pharynx length. Pearson's product moment tests were performed to evaluate how pharyngeal pressure and timing events changed across bolus volume.
: Velopharyngeal duration, maximum tongue base pressure, tongue base pressure rise rate, UES opening duration, and total swallow duration varied significantly across bolus volume. Sex did not have an effect, whereas pharynx length appeared to affect tongue base pressure duration. Maximum velopharyngeal pressure and minimum UES pressure had a direct relationship with bolus volume, whereas maximum tongue base pressure had an inverse relationship. Velopharyngeal pressure duration, UES opening duration, and total swallow duration increased as bolus volume increased.
: Differences in pharyngeal pressures and timing of key pressure events were detected across varying bolus volumes. Knowing the relationships between bolus volume and pharyngeal pressure activity can be valuable when diagnosing and treating dysphagic patients.

Download full-text

Full-text

Available from: Michelle R Ciucci, Mar 14, 2014
0 Followers
 · 
134 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: We present an algorithm developed in MATLAB that can be applied to both normal and disordered swallowing to automatically extract a wide array of measurements from the spatiotemporal plots produced by high-resolution manometry (HRM) of the pharyngeal swallow. The algorithm was developed from data from 12 normal and 3 disordered subjects swallowing 5-ml water boluses. Automated extraction was compared to manual extraction for a subset of seven normal and the three disordered subjects to evaluate algorithm accuracy. Area and line integrals, pressure wave velocity, and pressure gradients during upper esophageal sphincter opening were also measured. Automated extraction showed strong correlations with manual extraction, producing high correlation coefficients in both normal and disordered subjects for maximum velopharyngeal pressure and maximum tongue base pressure. Timing data were also strongly correlated for all variables, including velopharyngeal pressure duration, tongue base pressure duration, and total swallow duration. Preliminary descriptive data on area and line integrals are presented. Our results indicate that the algorithm can effectively extract data automatically from HRM spatiotemporal plots. The efficiency of the algorithm makes it a valuable tool to supplement clinical and research use of HRM.
    Dysphagia 12/2010; 26(1):3-12. DOI:10.1007/s00455-010-9320-2 · 1.60 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Studies have shown anatomical and functional differences between men and women with respect to the mouth, pharynx, upper esophageal sphincter, and esophagus. The aim of this investigation was to analyze the influence of gender, body mass index (BMI), age, and orofacial anthropometric measurements on the intraoral maximum volume capacity for liquid. The investigation included asymptomatic subjects, 56 females and 44 males, aged 19-53 years. The volunteers sucked water through a straw up to the maximum tolerated oral volume, which was greater in men (71.2 ± 15.0 ml) than in women (55.4 ± 13.4 ml). Age, BMI, height, and number of teeth had no influence on the intraoral tolerated volume. Anthropometric orofacial measurements were greater in men than in women. In individuals with height between 1.66 and 1.89 m, anthropometric orofacial measurements were greater in men than in women, and the tolerated intraoral volume was greater in men than in women. There was a positive correlation between orofacial measurements and intraoral maximum volume. In conclusion, men have the capacity to place a larger volume of water inside their mouth than women. This observation is associated with higher anthropometric orofacial measures, but not with age, number of teeth, height, or BMI.
    Dysphagia 11/2011; 27(3):384-9. DOI:10.1007/s00455-011-9379-4 · 1.60 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Effortful swallow and the Mendelsohn maneuver are two common strategies to improve disordered swallowing. We used high-resolution manometry (HRM) to quantify the effects of these maneuvers on pressure and timing characteristics. Fourteen normal subjects swallowed multiple, 5-ml water boluses using three techniques: normal swallow, effortful swallow, and the Mendelsohn maneuver. Maximum pressure, rate, duration, area integral, and line integral were determined for the velopharynx and tongue base. Minimum pressure, duration of pressure-related change, duration of nadir pressure, maximum preopening and postclosure pressure, area integral, and line integral were recorded for the upper esophageal sphincter (UES). Area and line integrals of the velopharyngeal pressure curve significantly increased with the Mendelsohn maneuver; the line integral increased with the effortful swallow. Preopening UES pressure decreased significantly for the Mendelsohn, while postclosure pressure tended to increase insignificantly for both maneuvers. UES area and line integrals as well as nadir UES pressure duration increased with both maneuvers. Maneuver-dependent changes were observed primarily at the velopharynx and UES. These regions are critical to safe swallowing, as the velopharynx provides positive pressure at the bolus tail while the UES allows a bolus to enter the esophagus without risk of regurgitation. Integrals were more responsive than maximum pressure or duration and should be investigated further.
    Dysphagia 01/2012; 27(3):418-26. DOI:10.1007/s00455-011-9385-6 · 1.60 Impact Factor