Mechanisms of airway protection during retching, vomiting, and swallowing

2002 ◽  
Vol 283 (3) ◽  
pp. G529-G536 ◽  
Author(s):  
Ivan M. Lang ◽  
Nicole Dana ◽  
Bidyut K. Medda ◽  
Reza Shaker
Keyword(s):  
Muscle Activation ◽  
Smooth Muscles ◽  
Upper Esophageal Sphincter ◽  
Striated Muscles ◽  
Airway Protection ◽  
Laryngeal Elevation ◽  
Glottal Closure ◽  
Adductor Muscles ◽  
Pharyngeal Muscles ◽  
Subglottal Pressure

We investigated the mechanisms of airway protection and bolus transport during retching and vomiting by recording responses of the pharyngeal, laryngeal, and hyoid muscles and comparing them with responses during swallowing and responses of the gastrointestinal tract. Five dogs were chronically instrumented with electrodes on the striated muscles and strain gauges on smooth muscles. Retching and vomiting were stimulated by apomorphine (5–10 ug/kg iv). During retching, the hyoid and thyroid descending and laryngeal abductor muscles were activated; between retches, the hyoid, thyroid, and pharyngeal elevating, and laryngeal adductor muscles were activated. Vomiting always occurred during the ascending phase of retching and consisted of three sequential phases of hyoid and pharyngeal muscle activation culminating in simultaneous activation of all recorded elevating and descending laryngeal, hyoid, and pharyngeal muscles. Retrograde activation of esophagus and pharyngeal muscles occurred during the later phases, and laryngeal adductor was maximally activated in all phases of the vomit. During swallowing, the laryngeal adductor activation was followed immediately by brief activation of the laryngeal abductor. We concluded that retching functions to mix gastric contents with refluxed intestinal secretions and to impart an orad momentum to the bolus before vomiting. During retches, the airway is protected by glottal closure, and between retches, it is protected by ascent of the larynx and closure of the upper esophageal sphincter. The airway is protected by maximum glottal closure during vomiting. During swallowing, the airway is protected by laryngeal elevation and glottal closure followed by brief opening of the glottis, which may release subglottal pressure expelling material from the laryngeal vestibule.

scholarly journals Digestive and respiratory tract motor responses associated with eructation

2013 ◽  
Vol 304 (11) ◽  
pp. G1044-G1053 ◽  
Author(s):  
Ivan M. Lang ◽  
Bidyut K. Medda ◽  
Reza Shaker
Keyword(s):  
Respiratory Tract ◽  
Striated Muscle ◽  
Smooth Muscles ◽  
Upper Esophageal Sphincter ◽  
Gastric Distension ◽  
Thoracic Esophagus ◽  
Striated Muscles ◽  
Motor Responses ◽  
Esophageal Sphincter ◽  
Secondary Peristalsis

We studied the digestive and respiratory tract motor responses in 10 chronically instrumented dogs during eructation activated after feeding. Muscles were recorded from the cervical area, thorax, and abdomen. The striated muscles were recorded using EMG and the smooth muscles using strain gauges. We found eructation in three distinct functional phases that were composed of different sets of motor responses: gas escape, barrier elimination, and gas transport. The gas escape phase, activated by gastric distension, consists of relaxation of the lower esophageal sphincter and diaphragmatic hiatus and contraction of the longitudinal muscle of the thoracic esophagus and rectus abdominis. All these motor events promote gas escape from the stomach. The barrier elimination phase, probably activated by rapid gas distension of the thoracic esophagus, consists of relaxation of the pharyngeal constrictors and excitation of dorsal and ventral upper esophageal sphincter distracting muscles, as well as rapid contraction of the diaphragmatic dome fibers. These motor events allow esophagopharyngeal air movement by promoting retrograde airflow and opening of the upper esophageal sphincter. The transport phase, possibly activated secondary to diaphragmatic contraction, consists of a retrograde contraction of the striated muscle esophagus that transports the air from the thoracic esophagus to the pharynx. We hypothesize that the esophageal reverse peristalsis is mediated by elementary reflexes, rather than a coordinated peristaltic response like secondary peristalsis. The phases of eructation can be activated independently of one another or in a different manner to participate in physiological events other than eructation that cause gastroesophageal or esophagogastric reflux.

scholarly journals Self-Triggered Functional Electrical Stimulation During Swallowing

2005 ◽  
Vol 94 (6) ◽  
pp. 4011-4018 ◽  
Author(s):  
Theresa A. Burnett ◽  
Eric A. Mann ◽  
Joseph B. Stoklosa ◽  
Christy L. Ludlow
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Muscle Activity ◽  
Muscle Activation ◽  
Sensory Stimulation ◽  
Electromyographic Activity ◽  
Airway Protection ◽  
Laryngeal Elevation ◽  
Activity Onset ◽  
Dysphagic Patients

Hyolaryngeal elevation is essential for airway protection during swallowing and is mainly a reflexive response to oropharyngeal sensory stimulation. Targeted intramuscular electrical stimulation can elevate the resting larynx and, if applied during swallowing, may improve airway protection in dysphagic patients with inadequate hyolaryngeal motion. To be beneficial, patients must synchronize functional electrical stimulation (FES) with their reflexive swallowing and not adapt to FES by reducing the amplitude or duration of their own muscle activity. We evaluated the ability of nine healthy adults to manually synchronize FES with hyolaryngeal muscle activity during discrete swallows, and tested for motor adaptation. Hooked-wire electrodes were placed into the mylo- and thyrohyoid muscles to record electromyographic activity from one side of the neck and deliver monopolar FES for hyolaryngeal elevation to the other side. After performing baseline swallows, volunteers were instructed to trigger FES with a thumb switch in synchrony with their swallows for a series of trials. An experimenter surreptitiously disabled the thumb switch during the final attempt, creating a foil. From the outset, volunteers synchronized FES with the onset of swallow-related thyrohyoid activity (∼225 ms after mylohyoid activity onset), preserving the normal sequence of muscle activation. A comparison between average baseline and foil swallows failed to show significant adaptive changes in the amplitude, duration, or relative timing of activity for either muscle, indicating that the central pattern generator for hyolaryngeal elevation is immutable with short term stimulation that augments laryngeal elevation during the reflexive, pharyngeal phase of swallowing.

Relative contribution of various airway protective mechanisms to prevention of aspiration during swallowing

2003 ◽  
Vol 284 (6) ◽  
pp. G933-G939 ◽  
Author(s):  
Bidyut K. Medda ◽  
Mark Kern ◽  
Junlong Ren ◽  
Pengyan Xie ◽  
Seckin O. Ulualp ◽  
...  
Keyword(s):  
Airway Protection ◽  
Protective Mechanisms ◽  
Laryngeal Elevation ◽  
Glottal Closure ◽  
Relative Contribution ◽  
Primary Mechanism ◽  
Before And After ◽  
Ues Opening ◽  
Pharyngeal Clearance ◽  
Risk Of Aspiration

Deglutitive airway protective mechanisms include glottal closure, epiglottal descent, and anterosuperior displacement of the larynx. Aspiration of swallowed material may occur during the pre-, intra-, or postpharyngeal phase of swallowing. Our objectives were to determine the relative contribution of the airway protective mechanisms during each phase of swallow in 14 decerebrated cats before and after suprahyoid myotomy, epiglottectomy, and unilateral cordectomy. After myotomy, superior excursions of the hyoid, thyroid, and cricoid cartilages and anteroposterior diameter of maximum upper esophageal spincter (UES) opening were significantly diminished, but the incidence of pharyngeal residue significantly increased ( P < 0.05). No aspiration was observed in the predeglutitive period. After myotomy, the incidence of aspiration significantly increased in both intra- and postdeglutitive periods. Epiglottectomy did not alter aspiration incidence, but unilateral cordectomy resulted in a 100% incidence of intra- and postdeglutitive aspiration. In conclusion, glottal closure constitutes the primary mechanism for prevention of intra- and postdeglutitive aspiration, but laryngeal elevation may assist this function. Bolus pulsion without laryngeal distraction can open the UES, but at risk of aspiration due to decreased pharyngeal clearance. The epiglottis provides no apparent airway protection during any phase of swallowing.

scholarly journals Modeling the Pathophysiology of Phonotraumatic Vocal Hyperfunction With a Triangular Glottal Model of the Vocal Folds

2017 ◽  
Vol 60 (9) ◽  
pp. 2452-2471 ◽  
Author(s):  
Gabriel E. Galindo ◽  
Sean D. Peterson ◽  
Byron D. Erath ◽  
Christian Castro ◽  
Robert E. Hillman ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Muscle Activation ◽  
Maximum Flow ◽  
Vocal Folds ◽  
Element Model ◽  
Compensatory Mechanisms ◽  
Glottal Closure ◽  
Vocal Hyperfunction ◽  
Subglottal Pressure ◽  
Lumped Element Model

Purpose Our goal was to test prevailing assumptions about the underlying biomechanical and aeroacoustic mechanisms associated with phonotraumatic lesions of the vocal folds using a numerical lumped-element model of voice production. Method A numerical model with a triangular glottis, posterior glottal opening, and arytenoid posturing is proposed. Normal voice is altered by introducing various prephonatory configurations. Potential compensatory mechanisms (increased subglottal pressure, muscle activation, and supraglottal constriction) are adjusted to restore an acoustic target output through a control loop that mimics a simplified version of auditory feedback. Results The degree of incomplete glottal closure in both the membranous and posterior portions of the folds consistently leads to a reduction in sound pressure level, fundamental frequency, harmonic richness, and harmonics-to-noise ratio. The compensatory mechanisms lead to significantly increased vocal-fold collision forces, maximum flow-declination rate, and amplitude of unsteady flow, without significantly altering the acoustic output. Conclusion Modeling provided potentially important insights into the pathophysiology of phonotraumatic vocal hyperfunction by demonstrating that compensatory mechanisms can counteract deterioration in the voice acoustic signal due to incomplete glottal closure, but this also leads to high vocal-fold collision forces (reflected in aerodynamic measures), which significantly increases the risk of developing phonotrauma.

Mechanisms of airway protection and upper esophageal sphincter opening during belching

1992 ◽  
Vol 262 (4) ◽  
pp. G621-G628 ◽  
Author(s):  
R. Shaker ◽  
J. Ren ◽  
M. Kern ◽  
W. J. Dodds ◽  
W. J. Hogan ◽  
...  
Keyword(s):  
Vocal Cord ◽  
Hyoid Bone ◽  
Upper Esophageal Sphincter ◽  
Air Injection ◽  
Distinctive Pattern ◽  
Airway Protection ◽  
Glottal Closure ◽  
Closure Mechanism ◽  
Esophageal Sphincter ◽  
Ues Opening

The mechanisms of airway protection, upper esophageal sphincter (UES) opening, and their coordination during belching were studied with a concurrent videoendoscopic, videofluoroscopic, and manometric technique. Analysis of videoendoscopic recordings revealed that glottal function during gastric and esophageal belching was similar and consisted of vocal cord adduction resulting in closure of intoitus to trachea, followed by anterior-caudad movement of the glottis, followed by slitlike or triangular UES opening. When a belch episode was associated with an intragastric pressure increase, in addition to the above features, there was approximation of arytenoids to the base of the epiglottis before the UES opened. Duration of vocal cord closure during belches induced by 40 ml intraesophageal air injection was significantly longer than belches induced by 20 ml (P less than 0.01). Vocal cord closure preceded the UES opening invariably. Analysis of videofluoroscopic recordings showed that hyoid bone movement during belching had a distinctive pattern different from its movement during swallowing. UES opening started generally when the hyoid bone was pulled anteriorly. Anterior hyoid excursion of 0.78 +/- 0.1 cm during belching was significantly shorter than its excursion of 1.8 +/- 0.09 cm during swallowing (P less than 0.01). We conclude that glottal closure is an integral component of both esophageal and gastric belch reflexes that prevents aspiration of regurgitated material into the airway. Glottal closure mechanism during belching has two tiers of closure: 1) vocal cord closure and 2) aryepiglottic approximation. Glottal and UES functions are closely coordinated during belching, and finally, during belching, UES is pulled open after its relaxation.

Identification and characterization of the esophagoglottal closure reflex in a feline model

1994 ◽  
Vol 266 (1) ◽  
pp. G147-G153 ◽  
Author(s):  
R. Shaker ◽  
J. Ren ◽  
B. Medda ◽  
I. Lang ◽  
V. Cowles ◽  
...  
Keyword(s):  
Vocal Folds ◽  
Upper Esophageal Sphincter ◽  
Glottal Closure ◽  
Target Organs ◽  
Adductor Muscles ◽  
Suitable Animal Model ◽  
Cervical Vagotomy ◽  
Esophageal Sphincter ◽  
Feline Model

To identify a suitable animal model and to delineate the neural pathway and target organs of the esophagoglottal closure reflex we studied three species. Study showed the existence of an esophagoglottal closure reflex in cats. The presence of this reflex could not be documented in the opossum. In monkeys, because of the inadequacy of the available recording devices, its presence could not be ascertained. In the feline model, the closure response of the vocal folds to the abrupt generalized and segmental distension of the esophagus was similar to that of the humans. Study findings indicate that among glottal adductor muscles at least interarytenoid and lateral cricoarytenoid muscles are involved as target organs of the esophagoglottal closure reflex. Decerebration did not change the frequency of glottal closure response to esophageal distension, supporting the notion that this reflex is completely under brain stem control. Bilateral cervical vagotomy abolished the glottal closure induced by esophageal distension indicating that this reflex is mediated by the vagus nerve. Upper esophageal sphincter (UES) pressure response to esophageal distension by air was variable, suggesting that glottal and UES response to esophageal distension, although closely coordinated, are not dependent on one another. In summary, an esophagoglottal closure reflex exists in feline species, and many similarities in the elicitation and mediation of this reflex have been found with that of humans. This model could be used for further physiological studies.

Functional Anatomy Underlying Pharyngeal Swallowing Mechanics and Swallowing Performance Goals

2019 ◽  
Vol 4 (4) ◽  
pp. 648-655
Author(s):  
William G. Pearson ◽  
Jacline V. Griffeth ◽  
Alexis M. Ennis
Keyword(s):  
Functional Anatomy ◽  
Neuromuscular Control ◽  
Upper Esophageal Sphincter ◽  
Performance Goals ◽  
Laryngeal Elevation ◽  
Port Closure ◽  
Swallowing Dysfunction ◽  
Hyoid Movement ◽  
Pharyngeal Swallowing ◽  
Pharyngeal Constriction

Purpose Rehabilitation of pharyngeal swallowing dysfunction requires a thorough understanding of the functional anatomy underlying the performance goals of pharyngeal swallowing. These goals include the safe and efficient transfer of a bolus through the hypopharynx into the esophagus. Penetration or aspiration of a bolus threatens swallowing safety. Bolus residue indicates swallowing inefficiency. Several primary mechanics, or elements of the swallowing mechanism, underlie these performance goals, with some elements contributing to both goals. These primary mechanics include velopharyngeal port closure, hyoid movement, laryngeal elevation, pharyngeal shortening, tongue base retraction, and pharyngeal constriction. Each element of the swallowing mechanism is under neuromuscular control and is therefore, in principle, a potential target for rehabilitation. Secondary mechanics of pharyngeal swallowing, those movements dependent on primary mechanics, include opening the upper esophageal sphincter and epiglottic inversion. Conclusion Understanding the functional anatomy of pharyngeal swallowing underlying swallowing performance goals will facilitate anatomically informed critical thinking in the rehabilitation of pharyngeal swallowing dysfunction.

Upper airway muscle responsiveness to rising Pco 2 during NREM sleep

2000 ◽  
Vol 89 (4) ◽  
pp. 1275-1282 ◽  
Author(s):  
Giora Pillar ◽  
Atul Malhotra ◽  
Robert B. Fogel ◽  
Josee Beauregard ◽  
David I. Slamowitz ◽  
...  
Keyword(s):  
Muscle Activation ◽  
Slow Wave Sleep ◽  
Minute Ventilation ◽  
Upper Airway ◽  
Nrem Sleep ◽  
Dilator Muscle ◽  
Pharyngeal Muscles ◽  
Stage 2 Sleep ◽  
Significant Change ◽  
End Tidal

Although pharyngeal muscles respond robustly to increasing Pco 2 during wakefulness, the effect of hypercapnia on upper airway muscle activation during sleep has not been carefully assessed. This may be important, because it has been hypothesized that CO2-driven muscle activation may importantly stabilize the upper airway during stages 3 and 4 sleep. To test this hypothesis, we measured ventilation, airway resistance, genioglossus (GG) and tensor palatini (TP) electromyogram (EMG), plus end-tidal Pco 2(Pet CO2 ) in 18 subjects during wakefulness, stage 2, and slow-wave sleep (SWS). Responses of ventilation and muscle EMG to administered CO2(Pet CO2 = 6 Torr above the eupneic level) were also assessed during SWS ( n = 9) or stage 2 sleep ( n = 7). Pet CO2 increased spontaneously by 0.8 ± 0.1 Torr from stage 2 to SWS (from 43.3 ± 0.6 to 44.1 ± 0.5 Torr, P < 0.05), with no significant change in GG or TP EMG. Despite a significant increase in minute ventilation with induced hypercapnia (from 8.3 ± 0.1 to 11.9 ± 0.3 l/min in stage 2 and 8.6 ± 0.4 to 12.7 ± 0.4 l/min in SWS, P < 0.05 for both), there was no significant change in the GG or TP EMG. These data indicate that supraphysiological levels of Pet CO2 (50.4 ± 1.6 Torr in stage 2, and 50.4 ± 0.9 Torr in SWS) are not a major independent stimulus to pharyngeal dilator muscle activation during either SWS or stage 2 sleep. Thus hypercapnia-induced pharyngeal dilator muscle activation alone is unlikely to explain the paucity of sleep-disordered breathing events during SWS.

scholarly journals Effect of pharmacologically induced smooth muscle activation on permeability in murine colitis

2003 ◽  
Vol 12 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Freek J. Zijlstra ◽  
Marieke E. van Meeteren ◽  
Ingrid M. Garrelds ◽  
Maarten A.C. Meijssen
Keyword(s):  
Smooth Muscle ◽  
Intestinal Permeability ◽  
Muscle Activation ◽  
Tap Water ◽  
Water Solution ◽  
Smooth Muscles ◽  
Distal Colon ◽  
Mucosal Inflammation ◽  
Smooth Muscle Relaxation ◽  
Organ Bath

Background:Both intestinal permeability and contractility are altered in inflammatory bowel disease. Little is known about their mutual relation. Therefore, anin vitroorgan bath technique was developed to investigate the simultaneous effects of inflammation on permeability and smooth muscle contractility in different segments of the colon.Methods and materials:BALB/c mice were exposed to a 10% dextran sulphate sodium drinking water solution for 7 days to induce a mild colitis, while control mice received normal tap water. Intestinal segments were placed in an oxygenated organ bath containing Krebs buffer. Permeability was measured by the transport of the marker molecules3H-mannitol and14C-polyethyleneglycol 4000. Contractility was measured through a pressure sensor. Smooth muscle relaxation was obtained by salbutamol and l-phenylephrine, whereas contraction was achieved by carbachol and 1-(3-chlorophenyl)-biguanide.Results:The intensity of mucosal inflammation increased throughout the colon. Also, regional differences were observed in intestinal permeability. In both normal and inflamed distal colon segments, permeability was diminished compared with proximal colon segments and the non-inflamed ileum. Permeability in inflamed distal colon segments was significantly decreased compared with normal distal segments. Pharmacologically induced relaxation of smooth muscles did not affect this diminished permeability, although an increased motility positively affected permeability in inflamed and non-inflamed distal colon.Conclusions:Inflammation and permeability is inversely related. The use of pro-kinetics could counteract this disturbed permeability and, in turn, could regulate the disturbed production of inflammatory mediators.

scholarly journals Thermodynamic Aspects of Flagellar Activity

1967 ◽  
Vol 47 (2) ◽  
pp. 249-265
Author(s):  
M. E. J. HOLWILL ◽  
N. R. SILVESTER
Keyword(s):  
Regression Line ◽  
Smooth Muscles ◽  
Activation Entropy ◽  
Striated Muscles ◽  
Kcal Mole ◽  
Thermal Dependence ◽  
Activation Free Energy ◽  
The Common ◽  
Cilia And Flagella ◽  
Rate Limiting

1. The frequencies of the beat of cilia and flagella from various organisms have been determined at temperatures in the range 5-35°C. 2. Values of the activation enthalpy (ΔH‡, kcal./mole) and activation entropy (ΔS‡, e.u.) derived from the thermal dependence of frequency show a linear correlation of the form, ΔS‡ = 3·25 ΔH‡-50·75. 3. The corresponding isokinetic activation free energy is 15·6 kcal./mole. 4. The results support a hypothesis that the breakdown of an ATP-ATPase complex could be the common rate-limiting reaction for flagellar activity. 5. Values of ΔH‡ and ΔS‡ for the decay of length or tension in striated muscles also fall on the same regression line but some smooth muscles show deviations.

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