scholarly journals The Effect of Bolus Volume on Hyoid Kinematics in Healthy Swallowing

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
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.

Opening mechanisms of the human upper esophageal sphincter

1989 ◽  
Vol 257 (5) ◽  
pp. G748-G759 ◽  
Author(s):  
I. J. Cook ◽  
W. J. Dodds ◽  
R. O. Dantas ◽  
B. Massey ◽  
M. K. Kern ◽  
...  
Keyword(s):  
Normal Subjects ◽  
Upper Esophageal Sphincter ◽  
Feedback Mechanism ◽  
Bolus Volume ◽  
Cross Sectional ◽  
Early Entry ◽  
Hyoid Movement ◽  
Esophageal Sphincter ◽  
Ues Opening ◽  
High Pressure Zone

Our goals in this study were to evaluate the mechanisms operative in swallow-associated opening of the upper esophageal sphincter (UES) and to determine the dynamics of fluid flow across the sphincter. For this purpose, we obtained concurrent videofluorographic and manometric studies of 2- to 30-ml barium swallows in 15 normal subjects. We found that the resting UES high-pressure zone corresponded closely with the location of the cricopharyngeus. The findings indicated that manometric UES relaxation and anterior hyoid traction on the larynx invariably preceded UES opening. With graded increases in bolus volume, progressive increases occurred in UES diameter, cross-sectional area, flow duration, and transsphincteric flow rate. Intrabolus pressure upstream to the UES and within the UES at its opening during transsphincteric flow of barium remained within a narrow physiological range of less than 10 mmHg up to a bolus volume of 10 ml. With increases in bolus volume, anterior hyoid movement, UES relaxation, and UES opening occurred sooner in the swallow sequence to accommodate the early entry of large boluses into the pharynx. We conclude that during swallowing 1) normal UES opening involves sphincter relaxation, anterior laryngeal traction, and intrabolus pressure, 2) volume-dependent adaptive changes in UES dimension accommodate large bolus volumes and flow rates with minimal requirement for increases in upstream, or intrasphincteric, intrabolus pressure or UES opening duration, and 3) volume-dependent changes in UES dimensions as well as timing of UES relaxation and opening indicate a sensory feedback mechanism that modulates some components of the swallow response generated by the brain stem swallow centers.

scholarly journals INFLUENCE OF AGE ON SWALLOWS OF A HIGHLY VISCOUS LIQUID BOLUS

2015 ◽  
Vol 52 (1) ◽  
pp. 32-36 ◽  
Author(s):  
Weslania Viviane NASCIMENTO ◽  
Carla Manfredi SANTOS ◽  
Rachel Aguiar CASSIANI ◽  
Roberto Oliveira DANTAS
Keyword(s):  
Viscous Liquid ◽  
Upper Esophageal Sphincter ◽  
Hyoid Movement ◽  
Older Subjects ◽  
Esophageal Sphincter ◽  
Pharyngeal Transit ◽  
Pharyngeal Clearance ◽  
Liquid Bolus ◽  
Asymptomatic Subjects ◽  
Swallow Function

Background Swallow function has a decline with aging, mainly in those over 80 years old. In the population over 69 years, about 11% of subjects reported symptoms indicative of significant dysphagia. Objectives Our objective was to evaluate the hypothesis that older asymptomatic subjects before 80 years old have compensations to sustain a safe and efficient swallow, at least with swallows of liquid bolus. Methods We performed videofluoroscopic evaluation of swallows in 55 normal volunteers, a younger group with 33 subjects (16 men and 17 women) aged 19 to 55 years, mean 35.5±9.8 years, and an older group with 22 subjects (15 men and 7 women) aged 56 to 77 years, mean 64.8±6.8 years. The subjects swallowed in duplicate 5 mL and 10 mL of liquid barium with a pH of 7.9, density of 1.82 g/cm3, and viscosity of 895 cp. Results The mean duration of pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were longer in the younger group compared with the older group. The relation between pharyngeal clearance duration and hyoid movement duration was similar in younger and older subjects, for 5 mL and 10 mL bolus volumes. Conclusions On average, a highly viscous liquid bolus crosses the pharynx faster in older subjects (56-77 years old) than in younger subjects (19-55 years old), which suggested an adaptation to the aging process to maintain a safe swallow.

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

2006 ◽  
Vol 290 (3) ◽  
pp. G458-G465 ◽  
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.

scholarly journals Response of the esophageal body to wet and dry swallows in Chagas' disease

2008 ◽  
Vol 45 (3) ◽  
pp. 195-198 ◽  
Author(s):  
Roberto Oliveira Dantas ◽  
Lilian Rose Otoboni Aprile
Keyword(s):  
Chagas Disease ◽  
Area Under The Curve ◽  
Normal Subjects ◽  
Upper Esophageal Sphincter ◽  
Control Group ◽  
Esophageal Body ◽  
Esophageal Sphincter ◽  
The Difference ◽  
Liquid Bolus ◽  
Esophageal Contraction

BACKGROUND: Wet swallows cause a greater esophageal contraction amplitude and duration than dry swallows. In Chagas' disease there is a reduction in amplitude of esophageal contraction but we do not know if the difference between wet and dry swallows is seen in the disease. AIM: To compare the esophageal contractions after wet and dry swallows in patients with Chagas' disease. METHODS: We measured the area under the curve (amplitude x duration) of the esophageal contractions in 30 patients with a diagnosis of esophageal involvement by Chagas' disease and 44 controls. We used the manometric method with continuous perfusion. The contractions were measured at 2, 7, 12 and 17 cm below the upper esophageal sphincter, after five swallows of a 5 mL bolus of water alternated with five dry swallows. RESULTS: In the control group wet swallows caused a higher area under the curve than dry swallows. There was no difference between wet and dry swallows in Chagas' disease patients, and there was no difference in wet and dry swallows in Chagas' disease patients compared with dry swallows of controls. At 12 and 17 cm from the upper esophageal sphincter the area under the curve after wet and dry swallows in Chagas' disease patients younger than 60 years (n = 15) was higher than in Chagas' disease patients older than 60 years (n = 15). CONCLUSION: We conclude that in normal subjects there is adaptation to the presence of a liquid bolus inside the esophageal body, which does not happen in patients with Chagas' disease.

Biomechanics of failed deglutitive upper esophageal sphincter relaxation in neurogenic dysphagia

2002 ◽  
Vol 283 (1) ◽  
pp. G16-G26 ◽  
Author(s):  
Rohan B. H. Williams ◽  
Karen L. Wallace ◽  
Galib N. Ali ◽  
Ian J. Cook
Keyword(s):  
Biomechanical Properties ◽  
Upper Esophageal Sphincter ◽  
Zenker’S Diverticulum ◽  
Bolus Volume ◽  
Neurogenic Dysphagia ◽  
Zenker's Diverticulum ◽  
Pharyngeal Swallow ◽  
Extrapyramidal Disease ◽  
Esophageal Sphincter ◽  
Ues Opening

Our aims were to examine the etiology and biomechanical properties of the nonrelaxing upper esophageal sphincter (UES) and the relationship between UES opening and failed relaxation. We examined the relationships among swallowed bolus volume, intrabolus pressure, sagittal UES diameter, the pharyngeal swallow response, and geniohyoid shortening in 18 patients with failed UES relaxation, 23 healthy aged controls, and 15 with Zenker's diverticulum. Etiology of failed UES relaxation was 56% medullary disease, 33% Parkinson's or extrapyramidal disease; and 11% idiopathic. Extent of UES opening ranged from absent to normal and correlated with preservation of the pharyngeal swallow response ( P = 0.012) and geniohyoid shortening ( P = 0.046). Intrabolus pressure was significantly greater compared with aged controls ( P < 0.001) or Zenker's diverticulum ( P < 0.001). The bolus volume-dependent increase in intrabolus pressure evident in controls was not observed in failed UES relaxation. The nonrelaxing UES therefore displays a constant loss of sphincter compliance throughout the full, and potentially normal, range of expansion during opening. Adequacy of UES opening is influenced by the degree of preservation of the pharyngeal swallow response and hyolaryngeal traction. In contrast, the stenotic UES displays a static loss of compliance, only apparent once the limit of sphincter expansion is reached.

Quantitative relationship between liquid bolus flow and laryngeal closure during deglutition

1993 ◽  
Vol 265 (4) ◽  
pp. G704-G711 ◽  
Author(s):  
D. J. Maddock ◽  
R. J. Gilbert
Keyword(s):  
Exposure Time ◽  
Head Movement ◽  
Time Interval ◽  
Bolus Volume ◽  
Pharyngeal Wall ◽  
Laryngeal Closure ◽  
Laryngeal Exposure ◽  
Tail Movement ◽  
Hyoid Movement ◽  
Liquid Bolus

We employed digital image analysis to assess the relative movements of the hyoid, larynx, and bolus as a function of liquid bolus volume (2-15 ml), and synchronized these measurements with intrapharyngeal manometry. Comparisons were performed of bolus head and tail movement in relation to the timing of hyoid movement, contact between the arytenoid and epiglottic cartilages, and intrabolus pressures. Bolus head movement in the distal pharynx, as determined from flow plots, was relatively rapid. Initial bolus tail movement in the distal pharynx was delayed proportional to bolus volume, and once initiated, was slower than bolus head movement. Laryngeal exposure time, defined as the interval between bolus head arrival and tail departure at the hypopharyngeal recording sensor, increased as a function of bolus volume. The time interval between the initial anterior hyoid movement and bolus arrival at the larynx, determined by concurrent plotting of hyoid excursion and bolus head position, was constant despite increasing bolus volume. Similarly, the interval between epiglottic-arytenoid contact and bolus arrival was constant despite increased bolus volume. The early phase of intrabolus pressure was temporally associated with posterior movement of the tongue base and varied as a function of bolus volume, whereas late intrabolus pressure was temporally associated with initial pharyngeal wall movement and was not significantly volume dependent. These data indicate that the temporal relationship between laryngeal closure and bolus head flow remains constant despite changes of laryngeal exposure time to the bolus as a function of volume.

Influence of altered tongue contour and position on deglutitive pharyngeal and UES function

1997 ◽  
Vol 273 (5) ◽  
pp. G1071-G1076 ◽  
Author(s):  
G. N. Ali ◽  
I. J. Cook ◽  
T. M. Laundl ◽  
K. L. Wallace ◽  
D. J. De Carle
Keyword(s):  
Healthy Volunteers ◽  
Upper Esophageal Sphincter ◽  
Bolus Volume ◽  
Potential Influence ◽  
Transit Times ◽  
Esophageal Sphincter

The potential influence of altered lingual position and contour during the bolus loading phase of the swallow in mediating the swallowed bolus volume-dependent regulation of upper esophageal sphincter (UES) relaxation and opening was studied in 15 healthy volunteers using simultaneous videoradiography and manometry. A maxillary dental splint modulated tongue deformity during the early oral phase of deglutition. We examined the effect of the splint and swallowed bolus density on bolus volume-dependent changes in the timing of events in the swallow sequence and on hypopharyngeal intrabolus and midpharyngeal pressures. Peak midpharyngeal pressure ( P = 0.001) and hypopharyngeal intrabolus pressure ( P = 0.04) were significantly reduced by the splint. The normal volume-dependent earlier onset of sphincter relaxation and opening was preserved with the splint in situ. The splint significantly delayed the onset of hyoid motion and UES relaxation and opening without influencing transit times or total swallow duration. Alterations in tongue contour and position reduce intrabolus pressure and pharyngeal contraction without influencing normal bolus volume-dependent regulation of timing of UES relaxation and opening.

Kinematic and Dynamic Characteristics of Solid Pellet Movement during the Pharyngeal Phase of Swallowing

1996 ◽  
Vol 105 (9) ◽  
pp. 716-723 ◽  
Author(s):  
Junlong Ren ◽  
Candy L. Hofmann ◽  
Mark K. Kern ◽  
Ronald C. Arndorfer ◽  
Reza Shaker
Keyword(s):  
Solid Particle ◽  
Dynamic Characteristics ◽  
Upper Esophageal Sphincter ◽  
The Other ◽  
Airway Protection ◽  
Particle Movement ◽  
Pharyngeal Wall ◽  
Pharyngeal Phase ◽  
Esophageal Sphincter ◽  
Liquid Bolus

Information on solid particle movement through the pharynx, in addition to its physiologic importance, has relevance to the swallowing of medications in pill form. The purpose of this study was to determine the kinematics of a solid particle during the oral-pharyngeal phase of swallowing. We used a concurrent manometric-videofluoroscopic technique and identified two distinct zones of increasing bolus velocity, one at the tongue base and the other at the pharyngo-upper esophageal sphincter (UES) region. Velocity decreased significantly (p < .05), to 9.0 ± 1.0 cm/s, while the bolus traversed the area located between the tip of the horizontal epiglottis and the pharyngeal wall. The velocity of the liquid barium bolus head was similar to that of the solid barium pellet. The average bolus tail velocity was relatively constant. The acceleration of the barium pellet was temporally associated with development of an incrementally decreasing pressure distal to the location of the pellet in the hypopharynx and across the UES. In conclusion, the kinematics of a solid particle are similar to those of the head of a liquid bolus, but both are different from bolus tail kinematics. During the pharyngeal phase of swallowing, the area located ahead of the bolus exhibits an incrementally decreasing pressure, caudally. This may facilitate bolus transport and contribute to airway protection.

Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry

2006 ◽  
Vol 291 (3) ◽  
pp. G525-G531 ◽  
Author(s):  
Sudip K. Ghosh ◽  
John E. Pandolfino ◽  
Qing Zhang ◽  
Andrew Jarosz ◽  
Peter J. Kahrilas
Keyword(s):  
Solid State ◽  
High Resolution ◽  
Detailed Analysis ◽  
Automated Analysis ◽  
Upper Esophageal Sphincter ◽  
Normative Values ◽  
Bolus Volume ◽  
High Resolution Manometry ◽  
Pressure Profiles ◽  
Esophageal Sphincter

This study aimed to use a novel high-resolution manometry (HRM) system to establish normative values for deglutitive upper esophageal sphincter (UES) relaxation. Seventy-five asymptomatic controls were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record from the hypopharynx to the stomach. Subjects performed ten 5-ml water swallows and one each of 1-, 10-, and 20-ml volume swallows. Pressure profiles across the UES were analyzed using customized computational algorithms that measured 1) the relaxation interval (RI), 2) the median intrabolus pressure (mIBP) during the RI, and 3) the deglutitive sphincter resistance (DSR) defined as mIBP/RI. The automated analysis succeeded in confirming bolus volume modulation of both the RI and the mIBP with the mean RI ranging from 0.32 to 0.50 s and mIBP ranging from 5.93 to 13.80 mmHg for 1- and 20-ml swallows, respectively. DSR was relatively independent of bolus volume. Peak pharyngeal contraction during the return to the resting state postswallow was almost 300 mmHg, again independent of bolus volume. We performed a detailed analysis of deglutitive UES relaxation with a novel HRM system and customized software. The enhanced spatial resolution of HRM allows for the accurate, automated assessment of UES relaxation and intrabolus pressure characteristics, in both cases confirming the volume-dependent effects and absolute values of these parameters previously demonstrated by detailed analysis of concurrent manometry/fluoroscopy data. Normative values were established to aid in future clinical and investigative studies.

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