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.

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Available from: Michelle R Ciucci, Mar 14, 2014
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    • "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. "
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