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: 2.14). 12/2010; 120(12):2367-73. DOI: 10.1002/lary.21150
Source: PubMed


: 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


Available from: Michelle R Ciucci, Mar 14, 2014
  • Source
    • "UES nadir was the only minimum value gathered in this study. Because nadir pressures occur during bolus flow through the UES (Jones & McCulloch, 2014) and nadir pressures have been shown to have a bolus effect (Butler et al., 2009; Hoffman, Ciucci, Mielens, Jiang, & McCulloch, 2010), it is possible that intrabolus pressure may have contributed to the increased nadir pressure phenomenon seen in this study. Therefore, other measures, such as the maximum post-closure UES pressure, may be a more meaningful measure of UES changes in response to effortful swallowing. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the effects of increased oral lingual pressure on pharyngeal pressures during swallowing in patients who have undergone radiotherapy for head and neck cancer. It was hypothesized that increased oral lingual pressure would result in increased pharyngeal pressures. A within subject experimental design was employed with 20 participants who were status post external beam radiotherapy for head and neck cancer. Participants completed typical swallows and swallows with increased lingual force during manofluoroscopic swallow studies. The swallow condition order was randomized across participants. Manometric data revealed significant differences in swallow pressure by condition at the base of tongue and upper esophageal sphincter sensor locations without significant pressure differences in the lower pharynx. The effortful lingual swallows resulted in higher mean pressures at all locations. The results of this study suggest use of a maneuver designed to increase oral tongue effort can also increase pharyngeal tongue base pressure. Therefore therapeutic activities employed to generate greater pressure of the oral tongue may also alter pharyngeal response. Further research is needed to determine the direct clinical impact on swallow function for individuals with head and neck cancer.
    Journal of Speech Language and Hearing Research 03/2015; 58(3). DOI:10.1044/2015_JSLHR-S-14-0210 · 2.07 Impact Factor
  • Source
    • "Swallowing motor output is modified by variations in bolus characteristics including volume, viscosity, taste, and temperature. These characteristics impact various biomechanical parameters of the swallow and include: 1) duration of upper esophageal sphincter (UES) opening10,38,47,50, 2) duration of swallow apnea9,44,45, 3) timing of pharyngeal phase initiation and laryngeal closure16,18,49, 4) lung volume at swallow initiation112,113, 5) oropharyngeal pressure10,47,82, 6) amplitude and duration of muscle activation17,104, and 7) total oropharyngeal swallow duration16,47,63,104. Similarly, cough motor output is modified by type of irritant (i.e., capsaicin, citric acid, fog, brandykinin, etc.)60,81, irritant concentration13,20,25,110, volume and duration of irritant presentation105, nasal afferent stimulation87,116, and lung volume at cough initiation99. These characteristics then result in modifications to cough inspiratory flow rate3,4, number of coughs produced22,25,60,74,81,105,110, self-reported urge to cough21,22, amplitude and duration of expiratory muscle activation during cough34,110, and cough expiratory airflow parameters43,60,110. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Deficits of airway protection can have deleterious effects to health and quality of life. Effective airway protection requires a continuum of behaviors including swallowing and cough. Swallowing prevents material from entering the airway and coughing ejects endogenous material from the airway. There is significant overlap between the control mechanisms for swallowing and cough. In this review we will present the existing literature to support a novel framework for understanding shared substrates of airway protection. This framework was originally adapted from Eccles' model of cough28 (2009) by Hegland, et al.42 (2012). It will serve to provide a basis from which to develop future studies and test specific hypotheses that advance our field and ultimately improve outcomes for people with airway protective deficits.
    Journal of applied oral science: revista FOB 07/2014; 22(4):251-260. DOI:10.1590/1678-775720140132 · 0.92 Impact Factor
  • [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 · 2.03 Impact Factor
Show more