Bolus Location at the Initiation of the Pharyngeal Stage of Swallowing in Healthy Older Adults |
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Authors: | Jennifer R Stephen MSc Donald H Taves MD Rebecca C Smith BSc Ruth E Martin PhD |
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Institution: | (1) School of Communication Sciences and Disorders, Faculty of Health Sciences, University of Western Ontario, Elborn College, London, Ontario;(2) Faculty of Medicine and Dentistry, University of Western Ontario, London, Ontario;(3) Department of Imaging/Diagnostic Radiology, St. Joseph’s Health Centre, London, Ontario, Canada;(4) Faculty of Health Sciences, University of Western Ontario, Elborn College, London, Ontario, N6G 1H1, Canada |
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Abstract: | This study characterized the vertical position of the bolus head at the onset of the pharyngeal swallow in healthy older adults.
Lateral-view videofluoroscopic (VF) images were obtained from ten healthy volunteers (age-71.6 ± 7.5 years, mean± SD) as they
swallowed 5-cc thin liquid barium aliquots. For each swallow, the bolus head and several anatomic landmarks were digitally
recorded from the image in which pharyngeal swallow-related hyoid bone elevation began. Vertical distance between the bolus
head and the intersection of the tongue base and mandibular ramus (TMI) was computed. Bolus head position at swallow onset
ranged from 47.4-mm above to 34.9-mm below the TMI (2.2 ± 14.4-mm, mean ± SD). Although the bolus head was below the level of the TMI for the majority of swallows, neither penetration nor aspiration occurred. For individual subjects,
mean bolus head position ranged from 25.8 ± 5.0-mm above to 15.5 ± 6.5-mm below the TMI. Whereas five of ten subjects initiated
the pharyngeal swallow with the bolus head consistently above or consistently below the TMI, five subjects initiated swallowing
with the bolus head either above or below the TMI across trials. Older adults commonly initiate thin-liquid swallows with
the bolus head well below the TMI without associated penetration or aspiration. Thus, bolus position alone does not differentiate
between normal and pathologic swallowing within the healthy elderly. Bolus position at pharyngeal swallow onset can vary substantially
from trial to trial within an individual, suggesting that the triggering of swallowing depends on multiple influences.
This research was supported by NSERC grant No. 0GPO171208 and an Ontario Ministry of Health Career Scientist Award to REM. |
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Keywords: | Swallowing Triggering Dysphagia Aspiration Bolus location Geriatric Deglutition Deglutition disorders |
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