Role of Laryngeal Movement and Effect of Aging on Swallowing Pressure in the Pharynx and Upper Esophageal Sphincter

Abstract

Objectives: Describe contribution of laryngeal movement to pressure changes at the upper esophageal sphincter (UES) and the effect of aging on the swallowing function. Study Design: Manofluorography on 56 nondysphagic adults divided into three age groups: the 21-to 31-year-old group (n ‫؍‬ 32), the 61-to 74-year-old group (n ‫؍‬ 12) and the 75-to 89-year-old group (n ‫؍‬ 12). Analyses of the bolus transit time, the amplitudes and durations of pharyngeal pressures, the timing of a pressure fall at the UES and the laryngeal movements. Methods: Intraluminal strain-gauge sensors recorded pressure changes in the oropharynx, hypopharynx and the UES. Motion pictures of the videotapes were fed into a personal computer, and movements of the hyoid bone were measured in both the horizontal and vertical directions as an indication of laryngeal movement. Results: In 26-and 70-year-old men with calcification of the thyroid cartilage, it was determined that the larynx and hyoid bone moved in consonance until the end of the rapid hyoid movements in both the superior and anterior directions. In the 21-to 31-year-old group, the magnitude of the pressure fall at the UES was maximal before or almost at the same time as the bolus arrival, in preparation for smooth passage of the bolus from the pharynx to the esophagus. The rapid superior movements of the hyoid bone started significantly early as compared with its anterior movements (P ‫؍‬ .0001). The rapid anterior movements of the hyoid bone started simultaneously with the pressure fall at the UES. In the elderly, all segmental transit times were significantly increased. The timing of the pressure fall at the UES was significantly delayed and the UES pressure reached its minimum value after arrival of the bolus at the UES. The minimum pressure at the UES increased to a significantly positive value. The rapid anterior movements of the hyoid were significantly delayed, suggesting that this delay causes the delay in the pressure fall at the UES. Conclusions:The rapid superior and anterior movements of the hyoid bone are considered to start at the same time as those of the larynx. In the young group, it is suggested that superior laryngeal movement protects the lower airway prior to the anterior laryngeal movement, causing the pressure fall at the UES to enable the passage of a bolus into the UES. In the elderly, smooth passage of the bolus from the pharynx to the esophagus is hindered and the system that prevents aspiration is rendered inefficient by changes in the swallowing pressures and laryngeal movements with aging.

Investigation of Pharyngeal Swallowing Function Using High‐Resolution Manometry

“…The foundations of HRM were laid in the early 1990s by Clouse and 1,3,5) . Whereas, the maximum values of the velopharyngeal and meso-hypopharyngeal pressures and the distances from the nasal nostril to the points of the maximum values of the meso-hypopharyngeal pressures and to the mid-point of the part showing the resting UES have never been reported precisely, probably because they used three or four-channel pressure transducers 1,3) .…”

“…Whereas, the maximum values of the velopharyngeal and meso-hypopharyngeal pressures and the distances from the nasal nostril to the points of the maximum values of the meso-hypopharyngeal pressures and to the mid-point of the part showing the resting UES have never been reported precisely, probably because they used three or four-channel pressure transducers 1,3) . Ghosh SK et al investigated the UES pressure using HRM, but they did not measure the swallowing pressures at velopharynx and meso-hypopharynx 5) .…”

“…However, interpretation of the results is more difficult in intra-esophageal manometry, because the results of examination are interpreted by analyzing the values of only a few sensors that are widely spaced about 2 cm or more between each other [1][2][3] . Due to this paucity of sensor population, it is difficult to detect the exact pressure of a specific point along the velopharynx and upper esophagus.…”

Análise da fisiologia da deglutição por meio da ultra-sonografia

“…O processo natural de evelhecimento também apresenta mudanças fisiológicas na deglutição, tais como: redução de força da musculatura orofacial na mastigação, diminuição da pressão lingual, dificuldades de iniciar a deglutição, regurgitação nasal, tosses, diminuição na elevação da excursão do hióide e laringe, mudanças na motilidade esofágica (36,37,38) .…”

“…São inúmeros os trabalhos a respeito da anatomia e fisiologia da deglutição em idosos saudáveis, evidenciando os sinais provenientes da deglutição senescente (4,37,38,39,40,41,42,43) .…”