Sequence Variability During Hypopharyngeal Bolus Transit

Abstract

The pharyngeal phase of deglutition is considered to occur in a reflexive, preprogrammed fashion. Previous studies have determined a general sequence of events based on the mean timing of bolus transit and swallowing gestures. Individual variability has not been studied, however. The purpose of this study was to determine the amount of sequence variability that normally occurs during the hypopharyngeal phase of deglutition. Dynamic swallow studies from 60 normal volunteers were evaluated and event sequence variability was determined for 12 two-event sequences during swallowing of three bolus sizes. There was found to be some variability in event sequences for almost all events evaluated except for the following: (1) arytenoid cartilage elevation always began prior to opening of the upper esophageal sphincter, (2) the sphincter always opened prior to the arrival of the bolus at the sphincter, (3) larynx-to-hyoid approximation always occurred after the onset of upper esophageal sphincter opening, and (4) maximum pharyngeal constriction always occurred after maximal distension of the upper esophageal sphincter. Variability was more common during swallowing of the smallest bolus size. This information may be helpful in evaluating event coordination in patients with dysphagia.

Event Sequence Variability in Healthy Swallowing: Building on Previous Findings

“…In a contrasting approach, Kendall and colleagues [13] sequenced both gestural and bolus events from the lateral view videofluoroscopies of 60 healthy volunteers (30 male) between 18 and 62 years of age, who each swallowed one bolus each of 1, 3, and 20ml Liquid Barosperse Barium Sulfate Suspension (60% w/v). The analysis investigated the degree to which the sequence varied for 12 separate event pairs, drawn :from the following events of interest:…”

The Sequence of Swallowing Events During the Chin-Down Posture

“…any research studies have explored the sequence of the events of swallowing and have revealed that there is considerable variability between and within healthy individuals (Cook et al, 1989;Gay, Rendell, Spiro, Mosier, & Lurie, 1994;Kendall, 2002;Kendall, Leonard, & McKenzie, 2003;Kendall, McKenzie, Leonard, Gonçalves, & Walker, 2000;Logemann et al, 2000;Logemann, Pauloski, Rademaker, & Kahrilas, 2002;McConnel, Cerenko, Jackson, & Guffin, Jr., 1988;Mendell & Logemann, 2007;Ohmae, Logemann, Kaiser, Hanson, & Kahrilas, 1995). Factors contributing to this variability include bolus volume, bolus consistency, age, and gender (Cook et al, 1989;Kendall, 2002;Kendall et al, 2003;Logemann et al, 2000Logemann et al, , 2002Mendell & Logemann, 2007;Ohmae et al, 1995).…”

“…Factors contributing to this variability include bolus volume, bolus consistency, age, and gender (Cook et al, 1989;Kendall, 2002;Kendall et al, 2003;Logemann et al, 2000Logemann et al, , 2002Mendell & Logemann, 2007;Ohmae et al, 1995). In individuals with dysphagia, the sequence of swallowing events is different from normal swallowing, likely due to the underlying swallowing disorder (Bisch, Logemann, Rademaker, Kahrilas, & Lazarus, 1994;Ekberg, 1986).…”

Análise da fisiologia da deglutição por meio da ultra-sonografia

“…3) Após a passagem do bolo alimentar pela transição faringo-esofágica, resultante da entrada de resíduos alimentares na região faríngea (32) .…”

“…O mecanismo básico de proteção laríngea consiste na inibição reflexa da respiração, fechamento do esfíncter glótico, elevação e deslocamento anterior da laringe em aproximação com o osso hióide, ficando sob a proteção da língua (30,31,32) .…”