Enhancing Swallowing-Respiration Coordination

Respiratory‐swallow coordination and swallowing impairment in head and neck cancer

“…The initiation of the swallow at mid‐to‐low lung volume is theorized to have mechanistic advantage to the safe ingestion of food and liquid 9,13,18,22,23,25,29 . Therefore, this investigation sought to also determine whether there was a link between the initiation of the swallow at this optimal lung volume range and measures of swallowing impairment.…”

“…Although a significant correlation between LVSI and swallowing impairment was not identified, it should be noted that the majority of the HNC patients were initiating swallows at lung volumes well above the optimal mid‐to‐low range of their baseline behavior. That is, the majority of the HNC patients demonstrated lung volumes above the normal range, which may account for some of the mechanistic challenges they face with tongue base retraction, hyolaryngeal movement, airway closure, and pharyngoesophageal segment opening 8,13,18,22‐25 …”

“…Respiration and swallowing must be coordinated to ensure safe exchange of gases for respiration and safe ingestion of food and liquids for nutrition 8‐21 . A typical swallow interrupts expiration, an essential element of airway protection, that decreases the risk of intrusion of food or liquid into the airway 8,9,22‐26 . The risk of aspiration during swallowing is heightened by discoordination between respiration and swallowing, specifically in patients with HNC 27 .…”

“…Optimal respiratory‐swallow coordination in healthy adults has also been characterized as initiating swallows at mid‐to‐low tidal lung volume relative to resting expiratory volume (REL) 23 . The initiation of the swallow during expiration and at mid‐to‐low lung volume (optimal respiratory‐swallow coordination) is theorized to have mechanistic advantages including facilitating airway closure, hyolaryngeal anterior‐superior movement, tongue base retraction, pharyngoesophageal segment opening, and lower esophageal opening 9,13,18,22,23,25,29 . Increased frequency of nonoptimal respiratory‐phase patterns in the dysphagic patients may signal greater impairment in swallowing physiology and airway protection.…”

Assessment of cough in head and neck cancer patients at risk for dysphagia—An overview

“…Despite a difference in kind between the two reflexes, this dissimilarity is not always taken into account in the framework of the management of dysphagia. 54 Unlike coughing that requires complete glottal closure, throat clearing is another reflexive or voluntary maneuver that removes laryngeal residue or mucus, but which involves partial vocal fold adduction. 43 Like the expiratory reflex, throat clearing does not have an inspiratory phase.…”