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1.
Postswallow residue is widely considered to be a sign of swallowing impairment and is assumed to pose risk for aspiration on subsequent swallows. We undertook a preliminary retrospective study to investigate the link between postswallow residue and penetration–aspiration on the immediately occurring subsequent clearing swallow (i.e., without introduction of a new bolus). Videofluoroscopy clips for 156 thin-liquid single bolus swallows by patients with neurogenic dysphagia were selected for study because they displayed multiple swallows per bolus. Residue for each subswallow (n = 407) was analyzed using the Normalized Residue Ratio Scale for the valleculae (NRRSv) and piriform sinuses. The association between residue presence at the end of a swallow and penetration–aspiration on the next swallow was examined. Postswallow residue in one or both pharyngeal spaces was significantly associated with impaired swallowing safety on the subsequent clearing swallow for the same bolus. However, when analyzed separately by residue location, only vallecular residue was significantly associated with impaired swallowing safety on the next clearing swallow. The distribution of NRRSv scores by swallowing safety demonstrated an NRRSv cut-point of 0.09, above which there was a 2.07 times greater relative risk of penetration–aspiration. Postswallow vallecular residue, measured using the NRRS, is significantly associated with penetration–aspiration on subsequent clearing swallows. A clinically meaningful cut-point of 0.09 on the NRRSv scale demarcates this risk. Further research with different bolus consistencies is needed. 相似文献
2.
The goal of this study was to examine deglutitive physiology during sequential straw drinking in healthy young adults (n = 15) to learn how sequential swallowing differs from single swallows. The physiology of single swallows has been studied extensively in healthy adults and in adults with a variety of debilitating conditions, but the physiology of sequential swallows has not been studied adequately. Videofluoroscopic analysis revealed three distinct patterns of hyolaryngeal complex (HLC) movement during sequential straw swallows: opening of the laryngeal vestibule after each swallow (Type I, 53%), continued vestibule closure after each swallow (Type II, 27%), and interchangeable vestibule opening and closing during the swallow sequence (Mixed, 20%). Unlike discrete swallowing, the onset of the pharyngeal swallow occurred when the bolus was inferior to the valleculae in the majority of subjects and was significantly associated with HLC movement pattern. The leading bolus edge was inferior to the valleculae at swallow onset for Type II movement patterns. For Type I movement patterns, bolus position at swallow onset was randomly distributed between three anatomical positions: superior to the valleculae, at the level of the valleculae, and inferior to the valleculae. Preswallow pharyngeal bolus accumulation, which is common during mastication, was evident and significantly associated with the HLC pattern of opened laryngeal vestibule after each swallow. These data suggest that in healthy young adults, sequential swallows differ physiologically from discrete swallows and indicate substantial variability in deglutitive biomechanics. 相似文献
3.
Pharyngeal clearance during swallowing: a combined manometric and videofluoroscopic study. 总被引:5,自引:0,他引:5
The deglutitive pharyngeal contraction was analyzed using simultaneous videofluoroscopic and manometric studies of eight volunteers. Anterior, posterior, and longitudinal movements of the pharyngeal surfaces, relative to the cervical vertebrae, were measured during swallows of 5 and 10 mL of liquid barium. Profound pharyngeal shortening during bolus transit through the pharynx eliminated access to the larynx and elevated the upper esophageal sphincter to within 1.5 cm of the retrolingual pharynx. Bolus head movement through the pharynx preceded the propagated pharyngeal contraction and registered manometrically as a slight intrabolus pressure before the major pressure complex. Contraction in the horizontal plane began after bolus head transit and culminated with stripping of the bolus tail through the pharynx. Prolonged upper sphincter opening with the larger-volume swallows resulted from a delayed onset rather than altered propagation of the horizontal pharyngeal contraction. It is concluded that the propagated pharyngeal contraction facilitates pharyngeal clearance but has a minimal role in the process of bolus propulsion during swallowing. The propagated contraction works in concert with profound pharyngeal shortening to minimize hypopharyngeal residue after a swallow. 相似文献
4.
Abstract
The purpose of this study was to evaluate radiographically the effects of cervical bracing upon swallowing thin liquids and
solid food in normal adults under three cervical bracing conditions. This was a prospective, repeated measures design study.
Seventeen healthy adult volunteers between the ages of 30 and 50 were recruited from hospital staff. All subjects reported
no previous history of swallowing difficulty or diseases that might affect swallowing. Subjects were radiographically observed
swallowing thin liquids and solid food without cervical bracing and with three common cervical orthoses (Philadelphia collar,
SOMI, and halo-vest brace). Order of bracing and type of bolus were randomized. Changes in swallowing function (point of initiation
of swallow response, presence of pharyngeal residue, airway penetration, hyoid bone movement, diameter of oropharyngeal airway,
and durational measurements) were analyzed by two independent raters. Eighty-two percent (14/17) of the subjects demonstrated
radiographic changes under one or more of the bracing conditions. Forty-seven percent (8/17) of subjects demonstrated changes
with point of initiation of the swallow response, 59% (10/17) demonstrated increased pharyngeal residue, and 23.5% (4/17)
demonstrated changes with bolus flow with laryngeal penetration present. Aspiration did not occur under any of the bracing
conditions. Changes noted in durational measurements for oral containment and total pharyngeal transit under the bracing conditions
were not considered statistically significant. This study shows that cervical bracing does change swallowing physiology in
normal healthy adults. 相似文献
5.
The purpose of this prospective study was to determine if fiberoptic endoscopic evaluation of swallowing (FEES) maintains high intra- and interrater reliability in detecting pharyngeal dysphagia and aspiration without the addition of FD&C Blue No. 1 to food. Twenty consecutive adults referred for a swallow evaluation participated. Nine subjects received blue-dyed food and 11 subjects received regular nondyed food, i.e., yellow pudding and white skim milk. Four variables were rated: (1) the stage transition characterized by depth of bolus flow to at least the vallecula prior to the pharyngeal swallow; (2) evidence of bolus retention in the vallecula or pyriform sinuses after the pharyngeal swallow; (3) laryngeal penetration defined as material in the laryngeal vestibule but not passing below the level of the true vocal folds either before or after the pharyngeal swallow; and (4) tracheal aspiration defined as material below the level of the true vocal folds either before or after the pharyngeal swallow. Three speech–language pathologists experienced in interpreting FEES results independently and blindly reviewed the digitized videotape three times. Intrarater agreements for the four variables with blue-dyed and non-blue-dyed food trials were 100% and monochrome trials ranged from 95% to 100%. Average kappa values for interrater reliability ranged from moderate to excellent agreement (0.61–1.00) for all viewing conditions. Kappa values for blue-dyed trials versus monochrome trials were 0.83 and for non-blue-dyed trials versus monochrome trials were 0.88, indicative of excellent reliability under both viewing conditions. FEES maintains both high intra- and interrater reliability in detecting the critical features of pharyngeal dysphagia and aspiration using either blue-dyed or non-blue-dyed foods. The endoscopist, therefore, can be assured of reliable FEES results using regular, non-dyed food trials.This research was supported in part by the McFadden, Harmon, and Mirikitani Endowments. 相似文献
6.
目的 通过电视X线透视吞咽功能的研究 ,评价健康老年妇女液体吞咽运动 ,并对液体吞咽运动的影响因素进行分析。 方法 4 0例健康老年妇女 ,老年前期组 (5 0~ 5 9岁 ) 2 0例 ;老年组 2 0例 ,年龄 6 0~ 79岁。进行电视X线透视液体吞咽功能检查 ,分别对口咽部相关结构进行运动学分析 ,比较不同液体食团体及年龄对健康老年妇女吞咽的影响。 结果 (1 )老年组较老年前期组渗透、口咽部滞留发生率增高 ,两组渗透发生率分别为 :7 5 %、3 8% ;口腔滞留发生率分别为 :1 2 5 %、6 3% ;咽腔滞留发生率分别为 :2 6 5 %、1 7 5 % ;口咽传递时间、腭咽部关闭时间及环咽部开放时间延长 (均为P <0 0 5 ) ;喉、舌骨向上运动距离增大 (P <0 0 5 )。 (2 ) 1 0ml食团较 1ml渗透、口咽部滞留发生率增高 ,两组渗透发生率分别为 :8 8%、2 5 % ;口腔滞留发生率分别为 :1 3 8%、5 0 % ;咽腔滞留发生率分别为 :31 3%、1 3 8% ;口传递时间缩短而环咽部开放时间延长 (均为P <0 0 5 ) ;喉向上、前运动 ,舌骨向前、向上运动的距离增大 (P <0 0 5 )。 结论 临床应用电视X线透视吞咽功能检查并对口咽期吞咽功能进行运动学分析是可行的 ;年龄及食团体积均影响健康老年妇女的液体吞咽功能 相似文献
7.
Ahmed Nagy Chelsea Leigh Sarah F. Hori Sonja M. Molfenter Tasnim Shariff Catriona M. Steele 《Dysphagia》2013,28(3):428-434
Temporal parameters such as stage transition duration, bolus location at swallow onset, and pharyngeal transit time are often measured during videofluoroscopy, but these parameters may vary depending on assessment instructions. Specifically, “command” (cued) swallows have been observed to alter timing compared to spontaneous (noncued) situations in healthy older adults. The aim of our study was to confirm whether healthy young people show timing differences for thin liquid swallows between cued and noncued conditions. Twenty healthy young adults swallowed 10-cc boluses of ultrathin barium in videofluoroscopy. The cued condition was to hold the bolus in the mouth for 5 s before swallowing. Three noncued swallows were also recorded. In the cued condition, bolus advancement to the pyriform sinuses prior to swallow initiation was seen significantly less frequently. Stage transition durations showed a nonsignificant trend toward being shorter. Pharyngeal transit times and pharyngeal response time (a measure capturing the interval between hyoid movement onset and bolus clearance through the upper esophageal sphincter) were both significantly longer in the cued condition. Our study in healthy young adults confirms findings previously observed in older adults, namely, that swallow onset patterns and timing differ between cued and noncued conditions. In particular, bolus advancement to more distal locations in the pharynx at the time of swallow onset is seen more frequently in noncued conditions. This pattern should not be mistaken for impairment in swallow onset timing during swallowing assessment. 相似文献
8.
This study investigated the swallowing physiology of toddler-aged patients with long-term tracheostomies. Structural movements
and motility of the pharyngeal stage of swallowing were studied in four toddlers ranging in age from 1:2 (years:months) to
2:9 with long-term tracheostomies. A patient aged 1:2 years with no tracheostomy served as a toddler model for comparison.
Videofluoroscopic recordings of the patients' liquid and puree bolus swallows were analyzed for a) onset times for pharyngeal
stage events, laryngeal vestibule closure, and tracheostomy tube movement; b) timeliness of swallow response initiation; and
c) pharyngeal transport function. Results found differences in timing of pharyngeal stage movements between the tracheostomized
patients and the patient with no tracheostomy. Laryngeal vestibule closure occurred before or within the same 0.033-s video
frame as onset of upper esophageal sphincter (UES) opening in the patient with no tracheostomy, but occurred 0.033–.099 s
after onset of UES opening in the tracheostomized patients. The time line required to close the laryngeal vestibule once the
arytenoids began their anterior movement was longer in the tracheostomized patients than in the patient with no tracheostomy
and was associated with laryngeal penetration. The patient with no tracheostomy displayed superior excursion of the arytenoid
and epiglottis during the swallowing; the tracheostomized patients did not. No association was found between onset of tracheostomy
tube movement and laryngeal vestibule closure. Delayed swallow response initiation was observed across tracheostomized patients
at a mean frequency of 45% with associated penetration. Pharyngeal dysmotility was not observed. Findings supported the concept
that long-term tracheostomy in toddler-aged patients affects swallowing physiology. 相似文献
9.
Kentaro Okuno Kanji Nohara Etsuko Takai Takayoshi Sakai John A. Fleetham Najib T. Ayas Alan A. Lowe Fernanda R. Almeida 《Dysphagia》2016,31(4):579-586
Swallowing is an important physiological response that protects the airway. Although aspiration during sleep may cause aspiration pneumonia, the mechanisms responsible have not yet been elucidated. We evaluated the coordination between respiration and swallowing by infusing water into the pharynx of healthy young adults during each sleep stage. Seven normal subjects participated in the study. During polysomnography recordings, to elicit a swallow we injected distilled water into the pharynx during the awake state and each sleep stage through a nasal catheter. We assessed swallow latency, swallow apnea time, the respiratory phase during a swallow, the number of swallows, and coughing. A total number of 79 swallows were recorded. The median swallow latency was significantly higher in stage 2 (10.05 s) and stage 3 (44.17 s) when compared to awake state (4.99 s). The swallow latency in stage 3 showed a very wide interquartile range. In two subjects, the result was predominantly prolonged compared to the other subjects. There was no significant difference in the swallow apnea time between sleep stages. The presence of inspiration after swallowing, repetitive swallowing, and coughing after swallowing was more frequent during sleep than when awake. This study suggests that the coordination between respiration and swallowing as a defense mechanism against aspiration was impaired during sleep. Our results supported physiologically the fact that healthy adult individuals aspirate pharyngeal secretions during sleep. 相似文献
10.
The electrophysiological features of voluntarily induced and reflexive/spontaneous swallows were investigated. In normal
subjects, swallows were elicited by infusing water either into the mouth (1–3 ml) or directly into the oropharyngeal region
through a nasopharyngeal cannula (0.3–1 ml). For water infused orally, subjects were either requested to swallow voluntarily
or instructed to resist swallowing and maintain the horizontal head position until swallowing occurred reflexively. Spontaneous
saliva swallowing was investigated in patients with severe dysphagia who had a prominent clinical picture of suprabulbar palsy.
Comparisons between different swallowing types were made by measuring the time interval between the onset of submental electromyographic
activity (SM-EMG) and the onset of the upward movement of the larynx recorded by a movement sensor. This interval was less
than 100 ms, even frequently less than 50 ms, in reflexive/spontaneous swallows, while in voluntarily induced swallows it
was substantially longer. The rising time of submental muscle's excitation was also shorter in reflexive/spontaneous swallows.
It was suggested that the triggering of voluntarily induced swallows commences more than 100 ms before the onset of swallowing
reflex and that this mechanism is under the control of corticobulbar–pyramidal pathways. If the swallowing reflex is triggered
within such a short period of time following the onset of SM-EMG, the central control by the bulbar swallowing center should
be effective until the end of oropharyngeal swallowing. 相似文献
11.
This study explored the influence of two methods of effortful swallow execution on the timing of pharyngeal pressure events.
Participants were asked to either emphasize or minimize tongue-to-palate contact during performance of the maneuver. Twenty
healthy participants were evaluated using concurrent submental surface electromyography (sEMG), orolingual manometry, and
pharyngeal manometry. Each subject performed three repetitions of three counterbalanced tasks (noneffortful dry swallows,
effortful dry swallows with tongue-to-palate emphasis, and effortful dry swallows with tongue-to-palate de-emphasis). Four
variables were measured: Onset Lag vs. sEMG Peak, Peak Lag vs. sEMG Peak, Total Duration, and Percent Rise Time to Peak. Compared
to noneffortful swallows, the effortful swallow task elicited significantly earlier onsets and peaks of pharyngeal pressures
relative to the submental sEMG peak. Total pressure event durations were greater and rise times were significantly shorter.
When comparing the two methods of effortful swallow execution, a longer latency to peak proximal pharyngeal pressure was found
in the tongue-to-palate emphasis condition. These results support the interpretation that the effortful swallow maneuver involves
generation of higher velocity bolus driving forces that propel the bolus into and through the pharynx with greater efficiency
and that pressure is then sustained to facilitate more complete bolus clearance.
Work performed at the Van der Veer Institute for Parkinson’s and Brain Research, Christchurch, New Zealand 相似文献
12.
Jeffrey B. Palmer M.D. Nathan J. Rudin M.D. Gustavo Lara B.A. Alfred W. Crompton Ph.D. 《Dysphagia》1992,7(4):187-200
The coordination of mastication, oral transport, and swallowing was examined during intake of solids and liquids in four normal
subjects. Videofluorography (VFG) and electromyography (EMG) were recorded simultaneously while subjects consumed barium-impregnated
foods. Intramuscular electrodes were inserted in the masseter, suprahyoid, and infrahyoid muscles. Ninety-four swallows were
analyzed frame-by-frame for timing of bolus transport, swallowing, and phases of the masticatory gape cycle. Barium entered
the pharynx a mean of 1.1 s (range −0.3 to 6.4 s) before swallow onset. This interval varied significantly among foods and
was shortest for liquids. A bolus of food reached the valleculae prior to swallow onset in 37% of sequences, but most of the
food was in the oral cavity at the onset of swallowing. Nearly all swallows started during the intercuspal (minimum gape)
phase of the masticatory cycle. Selected sequences were analyzed further by computer, using an analog-to-digital convertor
(for EMG) and frame grabber (for VFG). When subjects chewed solid food, there were loosely linked cycles of jaw and hyoid
motion. A preswallow bolus of chewed food was transported from the oral cavity to the oropharynx by protraction (movement
forward and upward) of the tongue and hyoid bone. The tongue compressed the food against the palate and squeezed a portion
into the pharynx one or more cycles prior to swallowing. This protraction was produced by contraction of the geniohyoid and
anterior digastric muscles, and occurred during the intercuspal (minimum gape) and opening phases of the masticatory cycle.
The mechanism of preswallow transport was highly similar to the oral phase of swallowing. Alternation of jaw adductor and
abductor activity during mastication provided a framework for integration of chewing, transport, and swallowing. 相似文献
13.
Pharyngeal swallow delay is frequently found in dysphagic patients and is thought to be a factor in a range of swallowing problems, including aspiration. Implicit in notions of swallow “delay” is a temporal interval between two events that is longer than normal. However, there appears to be little agreement about which referent events should be considered in determining delay. A number of pharyngeal bolus transit points and various pharyngeal gestures have been used in delays determined from fluoroscopic evidence, and other referents have been used in electromyographic and manometric studies of swallow. In this study latencies between the first movement of the hyoid and several pharyngeal bolus transit points were calculated from fluoroscopic swallow studies in normal nondysphagic adults. Means and standard deviations of these latencies are provided for a 3-cc and a 20-cc bolus and for both nonelderly and elderly adults. The data may be a useful resource for relating the specific latencies investigated to concepts of pharyngeal swallow delay, in particular, when assessing videofluoroscopic studies using a similar protocol. 相似文献
14.
Sandra L. Hamlet Ph.D. 《Dysphagia》1989,4(3):136-145
This investigation concerned the effect of different bolus volumes on the characteristics of lingual propulsive activity in
swallowing. Young normal subjects were asked to perform dry swallows and swallows of 5, 10, and 15 ml of water. Tongue activity
was recorded by tracking multiple gold pellets affixed to the tongue, utilizing the specialized research capabilities of the
X-ray Microbeam facility at the University of Wisconsin. The major differences were between dry and liquid swallows, with
dry swallows showing smaller range of movement, higher tongue position at the initiation of lingual propulsive activity, a
slightly different direction of motion, a humped or flat rather than grooved cross-sectional contour of the tongue, lower
peak velocity of motion, and slower progression of activity from tongue blade to dorsum. Within the 5–15 ml range of liquid
bolus volumes, fewer consistent differences were found as a function of bolus size, and some marked individual differences
in swallowing patterns were seen. Data are presented on normal within-subject variability in swallowing, with discussion of
the possible contribution of sensory assessment of bolus size to the modification of oral and pharyngeal characteristics of
swallowing. 相似文献
15.
Swallowing problems after excision of tumors of the skull base: Diagnosis and management in 12 patients 总被引:1,自引:0,他引:1
Acute-onset dysphagia can be a debilitating complication of operative intervention in skull base surgery. A retrospective
study performed at Baptist Hospital in vestigated the oropharyngeal deficits, compensatory swallow techniques, and diet modifications
of 12 patients who had undergone excision of skull base tumors. Oropharyngeal dysfunction, reduced laryngeal elevation, and
copious pharyngeal retention were the most prominent swallowing deficits. Aspiration occurred in 75% of the patients studied.
The most frequently employed compensatory swallow techniques were head turns to the affected side, supraglottic swallow, double
swallows, alternating liquids and solids, carbonated beverage swallows, and small bolus size. Approximately 2 weeks following
skull base surgery, 58% of the patients were able to tolerate oral intake with the aid of compensatory swallow techniques
and diet modifications. Only 1 patient in this group remained unable to tolerate food by mouth. This paper focuses on identification
of the disordered components of the swallow and the therapeutic management techniques characteristic of the patient who has
undergone excision of a skull base tumor. 相似文献
16.
The development of a solid-state intraluminal sphincter transducer has alleviated many of the problems associated with manometric
studies of the upper esophageal sphincter (UES) and pharynx (P). We used this technology to study the effect of position (upright
vs. supine) on resting UES pressures and the pressure dynamics of the UES/P complex during both wet and dry swallows in 11
normal volunteers and the effects of foods of different consistencies on the UES/P swallow dynamics in 10 normal volunteers.
The UES/P coordination parameters were defined as the 15 time intervals that can be measured between any 2 of 6 pertinent
points: the beginning, peak, and end of the pharyngeal contraction and the beginning, nadir, and end of the UES relaxation.
Data from both the circumferential transducer used to measure sphincter pressures and a standard microtransducer used to measure
pharyngeal pressures were collected on-line by an Apple IIe microcomputer and analyzed by programs written in our laboratory.
Significant changes in swallow coordination were measured between upright and supine swallows of the same bolus size, between
wet and dry swallows in the same position, and among foods of varying consistencies. Resting UES pressure was unchanged by
position and pharyngeal contraction pressure was unchanged by bolus size or consistency. 相似文献
17.
B-mode ultrasound imaging has been used primarily to detect temporal and spatial movements of the tongue during the oral
preparatory and oral stages of swallowing. The purpose of this study was to investigate the application of M-mode (motion
mode) ultrasound imaging as a method to quantify the duration and displacement of single regions along the lateral pharyngeal
wall during swallows of two bolus volumes and during three swallow maneuvers (supraglottic, super-supraglottic and Mendelsohn
maneuver). In 5 normal subjects, simultaneous B/M-mode images were captured at two regions along the lateral pharyngeal wall.
Computer-assisted video analysis of each swallow sequence provided spatial coordinates and durational measures. Results indicated
no significant differences in displacements of the lateral pharyngeal wall across bolus volumes, swallow maneuvers, or recording
sites. Significant differences (p < 0.001) in lateral pharyngeal wall duration occurred as a function of volitional swallow maneuvers. Greater durations (p < 0.05) were found for the Mendelsohn and super-supraglottic swallow maneuvers. The data demonstrate that B/M-mode ultrasound
imaging provides a simple, noninvasive method to visually examine movements of the lateral pharyngeal wall and may provide
a clinical method for assessing the effects of direct swallowing therapies at the level of the mid-oropharynx. 相似文献
18.
Abstract
The past two decades have brought an enormous widening of interest in and knowledge about swallowing disorders. The most frequently
used technique for swallow evaluation is X-ray videofluoroscopy. Most interventions are based on this examination. Only a
few studies assessing interobserver reliability of videofluoroscopy have been published. The aim of our study was to assess
the interobserver reliability of videofluoroscopy for swallow evaluation. Fifty-one consecutive dysphagic patients referred
for videofluoroscopy were entered into the study regardless of their underlying disorder. The first swallow (5 ml of a semisolid
radio-opague contrast media) of each patient was assessed in the lateral projection by 9 independent, experienced observers
from different international swallow centers. All studies were evaluated according to a standardized protocol sheet and the
interobserver reliability was calculated. The interobserver reliabilities assessed as kappa coefficient for parameters of
the oral and pharyngeal phase, for the temporal occurrence of penetration/aspiration, and for the location of bolus residue
ranged from 0.01 to 0.56. High reliability with an intraclass coefficient of 0.80 was achieved only with the well defined
penetration/aspiration score. Our study underlines the need for exact definitions of the parameters assessed by videofluoroscopy,
in order to raise interobserver reliability. To date, only aspiration is evaluated with high reliability by videofluoroscopy,
whereas the reliability of all other parameters of oropharyngeal swallow is poor. 相似文献
19.
《Respiration physiology》1994,95(2):181-193
We examined the effect of continuous swallowing on breathing pattern and ventilation in 7 adult subjects. Repetitive swallowing was induced by oral infusion of water at a variable rate of 40, 60, 80 or 100 ml/min, while the subject breathed through the nose. The number of swallows increased from a mean of 5.2 (±2.7 SD) swallows/min during the control period to 9.2 ± 2.0 to 13.7 ± 2.9 swallows/min during infusion of 40 and 100 ml/min, respectively. The duration of interruption of breathing was bolus volume-dependent, increasing from 0.55 ± 0.99 sec with a mean bolus volume of 4.6 ± 1.4 ml to 0.87 ± 0.23 sec with a bolus volume of 8.1 ± 1.9 ml. The majority of swallows (73 ± 12%) interrupted breathing during inspiration. The mean tidal volume, inspiratory and expiratory times during swallowing periods were higher than those recorded during the control period, but the mean level of ventilation was not different from control, at all swallowing frequencies. Repetitive swallowing did not result in a single incidence of aspiration or coughing. We conclude that mechanisms integrating breathing and swallowing allow repetitive swallowing to occur without compromising ventilation, and that these mechanisms perfectly orchestrate between breathing and deglutition to prevent aspiration. 相似文献
20.
Susan G. Butler Andrew Stuart Erika Wilhelm Catherine Rees Jeff Williamson Stephen Kritchevsky 《Dysphagia》2011,26(3):225-231
The reasons for aspiration in healthy adults remain unknown. Given that the pharyngeal phase of swallowing is a key component of the safe swallow, it was hypothesized that healthy older adults who aspirate are likely to generate less pharyngeal peak pressures when swallowing. Accordingly, pharyngeal and upper esophageal sphincter pressures were examined as a function of aspiration status (i.e., nonaspirator vs. aspirator), sensor location (upper vs. lower pharynx), liquid type (i.e., water vs. milk), and volume (i.e., 5 vs. 10?ml) in healthy older adults. Manometric measurements were acquired with a 2.1-mm catheter during flexible endoscopic evaluation. Participants (N?=?19, mean age?=?79.2?years) contributed 28 swallows; during 8 swallows, simultaneous manometric measurements of upper and lower pharyngeal and upper esophageal pressures were obtained. Pharyngeal manometric peak pressure was significantly less for aspirators (mean?=?82, SD?=?31?mmHg) than for nonaspirators (mean?=?112, SD?=?20?mmHg), and upper pharyngeal pressures (mean = 85, SD = 32?mmHg) generated less pressure than lower pharyngeal pressures (mean?=?116, SD?=?38?mmHg). Manometric measurements vary with respect to aspiration status and sensor location. Lower pharyngeal pressures in healthy older adults may predispose them to aspiration. 相似文献