Variations in the amplitude and duration of hyolaryngeal elevation during swallow: Effect of sour and carbonated liquid bolus

Background/Aims: The effortful swallow is a common treatment intervention requiring increased intensity to facilitate adaptations and modify swallow kinematics. The type of feedback and bolus volume provided may influence the intensity of the effortful swallow. To determine the increased effortful swallow intensity, a clinician can collect the peak amplitude of an effortful swallow and a typical swallow and compute a “swallow effort ratio” (SER). Dividing the effortful swallow surface electromyography (sEMG) peak amplitude by the typical swallow sEMG peak amplitude derives the SER. A higher SER suggests increased intensity. An increase in the SER may have clinical relevance in swallowing therapy as a threshold of intensity is required to elicit neuroplastic change. The purpose of this investigation was to determine whether sEMG visual and clinician verbal feedback increases the SER. Additionally, the investigation examined whether the SER is influenced by different liquid bolus volumes. Methods: Eighty-two nondysphagic, healthy adults were assigned at random to 2 groups. One group received no feedback, and the other received verbal and visual feedback while performing typical and effortful swallows at 3 liquid volumes. Results: An analysis of covariance compared the typical and effortful peak swallow amplitudes among 3 volumes in the 2 feedback groups. There was a significant effect on the peak amplitude values by feedback group F(2, 79) = 22.82, p < 0.001. There were no differences in peak amplitude by volume regardless of feedback F(2, 78) = 0.413, p = 0.663. Conclusion: It appears that sEMG visual and clinician verbal feedback increases the SER, which may be a surrogate for intensity. An increased SER may have a positive effect on swallow intervention as intensity is known to influence outcomes of exercise and elicit neuroplastic change.

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The Effect of Bolus Volume on Hyoid Kinematics in Healthy Swallowing

BioMed Research International ◽

10.1155/2014/738971 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 17

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.

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SWALLOWING IN PATIENTS WITH LARYNGITIS

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201800000-10 ◽

2018 ◽

Vol 55 (1) ◽

pp. 50-54 ◽

Cited By ~ 1

Author(s):

Isabela MODA ◽

Hilton Marcos Alves RICZ ◽

Lilian Neto AGUIAR-RICZ ◽

Roberto Oliveira DANTAS

Keyword(s):

Transit Time ◽

Random Sequence ◽

Acid Reflux ◽

Bolus Transit ◽

Normal Volunteers ◽

Esophageal Ph ◽

Solid Bolus ◽

Oral Preparation ◽

Pharyngeal Transit ◽

Liquid Bolus

ABSTRACT BACKGROUND: Dysphagia is described as a complaint in 32% of patients with laryngitis. OBJECTIVE: The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. METHODS: Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. RESULTS: The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. CONCLUSION: A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.

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Evaluation of liquid ingestion after bariatric surgery

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032011000100004 ◽

2011 ◽

Vol 48 (1) ◽

pp. 15-18 ◽

Cited By ~ 4

Author(s):

Roberto Oliveira Dantas ◽

Leda Maria Tavares Alves ◽

Rachel de Aguiar Cassiani ◽

Carla Manfredi dos Santos

Keyword(s):

Bariatric Surgery ◽

Body Mass Index ◽

Normal Values ◽

Normal Body Mass Index ◽

Class Iii ◽

Entire Volume ◽

Solid Foods ◽

Class Iii Obesity ◽

Swallowing Capacity ◽

Liquid Bolus

CONTEXT: Bariatric surgery is an effective treatment for obesity; however, after surgery the patient may have difficulty in swallowing liquid and solid foods. OBJECTIVES: To evaluate liquid ingestion in patients who had undergone bariatric surgery. METHOD: We studied 43 volunteers with normal body mass index (BMI) (BMI: 18.5-24.9 kg/m²), 55 subjects with class III obesity (BMI: >40.0 kg/m²), and 48 subjects with bariatric surgery for treatment of class III obesity. The method chosen for evaluation was the water swallowing test. The subjects drank in triplicate 50 mL of water while being precisely timed and the number of swallows were counted. RESULTS: There was no difference between subjects with normal BMI and subjects with class III obesity. During the first 2 months after bariatric surgery the patients showed an increase in the time needed to drink the entire volume, in the number of swallows, and in the inter-swallow interval, and a decrease in the volume swallowing capacity (volume/swallowing) and swallowing flow rate (volume swallowed/second). After 2 months, the results of the swallowing measurements moved in the direction of normal values. CONCLUSION: Bariatric surgery may cause more intense alterations of liquid bolus swallowing within 2 months after the procedure, which moved to normal values after this time.

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EFFECT OF SWALLOWED BOLUS VISCOSITY AND BODY POSITION ON ESOPHAGEAL TRANSIT, CONTRACTION AND PERCEPTION OF TRANSIT

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032015000100007 ◽

2015 ◽

Vol 52 (1) ◽

pp. 27-31 ◽

Cited By ~ 8

Author(s):

Juciléia DALMAZO ◽

Lilian Rose Otoboni APRILE ◽

Roberto Oliveira DANTAS

Keyword(s):

Supine Position ◽

Body Position ◽

Random Sequence ◽

Sitting Position ◽

Bolus Transit ◽

Esophageal Transit ◽

Asymptomatic Volunteers ◽

Bolus Viscosity ◽

Liquid Bolus ◽

Esophageal Contraction

Background The esophagus has a different response in relation to the characteristics of a swallowed bolus. Bolus viscosity and body position may affect esophageal contraction and transit. Objectives To investigate the effect of bolus viscosity and body position on esophageal contraction, transit and perception. Methods Esophageal contraction, transit and perception of transit were evaluated in 26 asymptomatic volunteers, 13 men and 13 women aged 18-60 years, mean: 33.6 (12.2) years. Esophageal contraction (manometry) and transit (impedance) were measured with a solid state catheter with sensors located 5, 10, 15, and 20 cm from the lower esophageal sphincter. Each volunteer swallowed in duplicate and in random sequence a 5 mL low viscous (LV) liquid bolus of an isotonic drink with pH 3.3, and a 5 mL high viscous (HV) paste bolus, which was prepared with 7.5 g of instant food thickener diluted in 50 mL of water (pH: 6.4). Results Total bolus transit time, in the sitting position, was longer with the HV bolus than with the LV bolus. Esophageal transit was longer in the supine position than in the sitting position. Bolus head advance time was longer with the HV bolus than with the LV bolus in both positions. Contraction esophageal amplitude was higher in the supine position than in the sitting position. The perception of bolus transit was more frequent with the HV bolus than with the LV bolus, without differences related to position. Conclusions The viscosity of the swallowed bolus and body position during swallows has an influence on esophageal contractions, transit and perception of transit.

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Effect of aging on bolus kinematics during the pharyngeal phase of swallowing

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00541.2004 ◽

2006 ◽

Vol 290 (3) ◽

pp. G458-G465 ◽

Cited By ~ 33

Author(s):

Eytan Bardan ◽

Mark Kern ◽

Ronald C. Arndorfer ◽

Candy Hofmann ◽

Reza Shaker

Keyword(s):

Pressure Gradient ◽

The Elderly ◽

Upper Esophageal Sphincter ◽

Elderly Subjects ◽

Kinematics And Dynamics ◽

Pressure Gradients ◽

Swallowing Difficulty ◽

Esophageal Sphincter ◽

Young Subjects ◽

Liquid Bolus

Swallowing difficulty is a common complaint in the elderly and, although there are data for the biomechanics of liquid swallows, little is known about solid bolus motion, or kinematics, in the elderly. The aims of this study were as follows: 1) to characterize and compare solid and liquid bolus kinematics in the elderly and compare the findings with those in young subjects and 2) to correlate bolus kinematics and dynamics. Concurrent manometric-fluoroscopic techniques were used to study eight young and eight elderly subjects. The subjects performed four swallows each of 0.2-cm-diameter solid barium pellets and 5 ml of liquid barium during sagittal fluoroscopy and six-channel pharyngoesophageal manometry. Images were digitized for analysis of kinematic properties such as velocity and acceleration. Dynamic pressures were recorded and coordinated with kinematic events. Image analysis showed that velocity varied as the pellet passed through the hypopharynx, pharynx, and upper esophageal sphincter. In young subjects, pellet kinematics were characterized by two zones of pellet acceleration: one over the tongue base and another as the pellet passed through the upper esophageal sphincter. Although the elderly showed a similar zone of acceleration over the base of the tongue, the second zone of pellet acceleration was not seen. Decreasing pressure gradients immediately distal to the position of the solid pellet and liquid bolus characterized dynamics for all subjects. This decreasing pressure gradient was significantly larger in elderly than in young subjects. Bolus kinematics and dynamics were significantly altered among elderly compared with young subjects. Among these differences were the absence of hypopharyngeal bolus acceleration and a significant increase in the transsphincteric pressure gradient in the elderly.

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Inferring the effects of saliva on liquid bolus flow using computer simulation

Computers in Biology and Medicine ◽

10.1016/j.compbiomed.2017.07.014 ◽

2017 ◽

Vol 89 ◽

pp. 304-313 ◽

Cited By ~ 4

Author(s):

Andrew Ho ◽

Rebecca Affoo ◽

Nicole Rogus-Pulia ◽

Mark Nicosia ◽

Yoko Inamoto ◽

...

Keyword(s):

Computer Simulation ◽

Liquid Bolus

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Videofluoroscopic analysis of different volumes of liquid bolus swallowing in healthy individuals: comparison between height and sex

Clinics ◽

10.6061/clinics/2017(11)08 ◽

2017 ◽

Vol 72 (11) ◽

pp. 693-697

Author(s):

MR Regueiro ◽

WV Nascimento ◽

LC Parreira ◽

RO Dantas

Keyword(s):

Healthy Individuals ◽

Liquid Bolus

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Physiologic Effects of Instilled and Aerosolized Surfactant Using a Breath-Synchronized Nebulizer on Surfactant-Deficient Rabbits

Pharmaceutics ◽

10.3390/pharmaceutics13101580 ◽

2021 ◽

Vol 13 (10) ◽

pp. 1580

Author(s):

Robert M. DiBlasi ◽

Kellie J. Micheletti ◽

Joseph D. Zimmerman ◽

Jonathan A. Poli ◽

James B. Fink ◽

...

Keyword(s):

Standard Dose ◽

Similar Efficacy ◽

Lung Lavage ◽

Bolus Administration ◽

Ventilation Efficiency ◽

Surfactant Administration ◽

Pre Treatment ◽

Liquid Bolus ◽

To Receive ◽

Economical Alternative

Surfactant administration incorporates liquid bolus instillation via endotracheal tube catheter and use of a mechanical ventilator. Aerosolized surfactant has generated interest and conflicting data related to dose requirements and efficacy. We hypothesized that aerosolized surfactant with a novel breath-actuated vibrating mesh nebulizer would have similar efficacy and safety as instilled surfactant. Juvenile rabbits (1.50 ± 0.20 kg, n = 17) were sedated, anesthetized, intubated, and surfactant was depleted via lung lavage on mechanical ventilation. Subjects were randomized to receive standard dose liquid instillation via catheter (n = 5); low dose surfactant (n = 5) and standard dose surfactant (n = 5) via aerosol; and descriptive controls (no treatment, n = 2). Peridosing events, disease severity and gas exchange, were recorded every 30 min for 3 h following surfactant administration. Direct-Instillation group had higher incidence for peridosing events than aerosol. Standard dose liquid and aerosol groups had greater PaO2 from pre-treatment baseline following surfactant (p < 0.05) with greater ventilation efficiency with aerosol (p < 0.05). Our study showed similar improvement in oxygenation response with greater ventilation efficiency with aerosol than liquid bolus administration at the same dose with fewer peridosing events. Breath-synchronized aerosol via nebulizer has potential as a safe, effective, and economical alternative to bolus liquid surfactant instillation.

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