Impaired deglutitive airway protection: A videofluoroscopic analysis of severity and mechanism

Kahrilas, Peter J.; Lin, Shing-Jong; Rademaker, Alfred; Logemann, Jerilyn A.

doi:10.1053/gast.1997.v113.pm9352847

Cited by 135 publications

(151 citation statements)

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“…This confirms our hypothesis that a deeper bolus position is associated with a risk of aspiration. Prior studies have reported a relationship between delayed swallow initiation of liquid and risk of aspiration in stroke survivors [8,11,20,21]. The present study extends this association to include two-phase food.…”

Section: Discussionsupporting

confidence: 70%

“…The swallowing of liquid and semi-solid food has been studied in individuals with dysphagia due to stroke [8,11,20,21] but little is known about how stroke affects the eating and swallowing of two-phase food. As such, the aim of the present study was to examine the impact of stroke on oral and pharyngeal food transport and swallow initiation while stroke survivors ate of two-phase food.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Food Consistencies and Mastication on Bolus Transport and Swallow Initiation in Individuals with Hemispheric Stroke

Matsuo

Yokoyama²,

Gonzalez-Fern³

et al. 2014

J Neurol Neurophysiol

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Mastication and food consistency each affect the passage of food through the oral cavity and pharynx and its coordination with swallow initiation. Since hemispheric stroke may damage cortico-medullary neural pathways, we hypothesized that it could also alter the coordination of eating and swallowing. Using videofluorography, we studied 30 individuals with hemispheric stroke and 27 age-matched controls as they consumed liquid barium, corned beef hash, or a combination of liquid and solid (two-phase) food. We tracked the leading edge of the barium during feeding and at swallow onset in relation to occurrences of laryngeal penetration and aspiration. Compared with asymptomatic controls, the leading edge remained in the hypopharynx before swallowing longer in stroke subjects (P = 0.016) and was lower in the foodway at swallow onset with two-phase food (P = 0.03) and liquid (P = 0.06). Penetration-aspiration scores were significantly higher for liquid and two-phase ingesta when the leading edge was deeper in the pharynx at swallow onset (P = 0.03). These findings suggest that stroke alters the coordination of bolus transport and swallowing, particularly with foods containing a liquid phase. With such an impairment, a bolus may enter the hypopharynx prematurely, thus increasing the risk of aspiration.

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Effects of Food Consistencies and Mastication on Bolus Transport and Swallow Initiation in Individuals with Hemispheric Stroke

Matsuo

Yokoyama²,

Gonzalez-Fern³

et al. 2014

J Neurol Neurophysiol

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“…However, whilst FEES was able to identify those pharyngeal stage deficits contributing to aspiration risk, it was unable to discern oral stage deficits that may limit overall ability for oral intake. As videofluoroscopy is generally unsuitable for use in the acute burns population 11 Numerous pharyngeal stage deficits have been found to be closely associated with increased risk of aspiration in other dysphagic populations, including pooling of saliva 33 , laryngotracheal pathology [34][35][36][37][38] , delayed swallow trigger 39 , impaired sensation 40 , reduced airway protection 41,42 , and the presence of pharyngeal residue 39,43 . In the current study all of these features were found to be prevalent, indicating that this is a clinical cohort at risk of aspiration due to multifactorial causes.…”

Section: Resultsmentioning

confidence: 99%

Physiological Characteristics of Dysphagia Following Thermal Burn Injury

et al. 2011

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1 This project was supported by funding from the Royal Brisbane and Women's Hospital (RBWH) Foundation. 2 Physiological characteristics of dysphagia following thermal burn injury 3 AbstractThe study aim was to document the acute physiological characteristics of the swallowing impairment following thermal burn injury. A series of 19 participants admitted to a specialised burn centre with thermal burn injury were identified with suspected aspiration risk by a clinical swallow examination (CSE) conducted by a speech-language pathologist and referred to the study. Once medically stable, each then underwent more detailed assessment using both a CSE and a fiberoptic evaluation of swallowing (FEES). Subsequent to this assessment, FEES confirmed 6 individuals (32%) had no aspiration risk, and were excluded from further analyses. Of the remaining 13, CSE confirmed two had specific oral phase deficits due to orofacial scarring and contractures, and all 13 had generalised oromotor weakness. FEES revealed numerous pharyngeal phase deficits with major finding evident in greater than 50% being: impaired secretion management, laryngotracheal edema, delayed swallow initiation, impaired sensation, inadequate movement of structures within the hypopharynx and larynx, and diffuse pharyngeal residue. Penetration and/or aspiration occurred in 83% (n = 10/12) of thin fluids trials, with a lack of response to the penetration/aspiration noted in 60% (n = 6/10 penetration/aspiration events) of cases. Most events occurred post swallow. Findings support that individuals with dysphagia post thermal burn present with multiple risk factors for aspiration that appear predominantly related to generalised weakness and inefficiency and further impacted by edema and sensory impairments. Generalised oromotor weakness and orofacial contractures (when present) impact oral stage swallow function. This study has identified a range of factors which may be contributing to both oral and pharyngeal stage dysfunction in this clinical population and highlights the 4 importance of using a combination of clinical and instrumental assessment to fully understand the influence of burn injury on oral intake and swallowing.

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“…The DSR was fairly uniform across different swallow volumes, thus acting as a normalizing parameter that removes volume dependent variations associated with relaxation duration and intrabolus pressure. This may prove useful in the clinical domain, because many patients with oropharyngeal dysphagia are unable to swallow larger bolus volumes safely (16). Hence, clinical studies performed only with lower volume boluses may be sufficient to assess the resistive properties of the sphincter and to guide therapeutic decisions.…”

Section: Discussionmentioning

confidence: 99%

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

Ghosh¹,

Pandolfino²,

Zhang³

et al. 2006

American Journal of Physiology-Gastrointestinal and Liver Physi

145

130

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. Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry. Am J Physiol Gastrointest Liver Physiol 291: G525-G531, 2006. First published April 27, 2006 doi:10.1152/ajpgi.00081.2006.-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. deglutitive sphincter resistance; relaxation interval; intrabolus pressure IT IS SOMEWHAT IRONIC that although the upper esophageal sphincter (UES) is the most accessible structure of the esophagus, it is in many ways the least well-understood. Several reflex pathways have been described linking the UES to the esophagus and pharynx (15,20,21,23,24) as have age-related changes in contractile vigor (2,7,22,25,31); however, with the exception of belch-related dysfunction (14, 15), none of these observations have yet been linked to pathological conditions. With respect to pathological conditions, the only clear dysfunction of the UES relates to alterations in its response during swallowing, specifically impaired UES opening during swallowing and impaired relaxation during swallow. Impaired opening, manifest as either stenosis with a cricopharyngeal bar or Zenker's diverticulum (5,8,26), is a recognized cause of dysphagia. Impaired relaxation is probably less common but can be related to neurological dysfunction, best characterized in the case of Parkinson's disease (1, 29). Thus, from a clinical perspective, the functional evaluation of the UES must, first an...

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Impaired deglutitive airway protection: A videofluoroscopic analysis of severity and mechanism

Cited by 135 publications

References 1 publication

Effects of Food Consistencies and Mastication on Bolus Transport and Swallow Initiation in Individuals with Hemispheric Stroke

Effects of Food Consistencies and Mastication on Bolus Transport and Swallow Initiation in Individuals with Hemispheric Stroke

Physiological Characteristics of Dysphagia Following Thermal Burn Injury

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

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