No abstract

The state-of-the-art technique, interpretation, predictive value, and safety of fiberoptic endoscopic evaluation of swallowing was reviewed.

The purpose of this study was to ascertain the normal relation of swallowing apnea (SA) onset relative to lingual bolus propulsion along with factors that may alter this relation. Forty adults, composed of 10 men and 10 women in each of 2 age groups (i.e., 20–30 and 63–79 years) participated. SA onset was assessed during 5- and 20-ml bolus volumes of water and apple juice across 3 trials. The effects of age, gender, bolus volume, bolus viscosity, and gustation on SA onset relative to lingual bolus propulsion were examined. A significant interaction of Age × Gender × Volume was found. In general, older adults initiated SA onset earlier than young adults, and large boluses elicited an earlier SA onset than small boluses regardless of group. Young men demonstrated significantly later SA onset than the older men for large volumes; this difference was not observed for small volumes, nor was it found between young and older women. SA onset also was assessed during 5-ml bolus volumes of thin apple juice, thick apple juice, and applesauce across three trials. A significant main effect of viscosity was found revealing that SA onset was initiated later as bolus viscosity increased. Thus, the results of this investigation provided data on the relation of SA onset relative to lingual bolus propulsion in individuals with normal swallowing and how this relation changes as a function of age, gender, bolus volume, bolus viscosity, and gustation.

The effect of effortful swallow on pharyngeal pressure and UES relaxation onsets and durations was examined. Eighteen adults, nine males and nine females (mean age=27.9 yr), participated. Timing of pharyngeal pressure and onset and duration of UES relaxation were measured across ten trials of normal and ten trials of effortful swallows. Results revealed that manometric timing measurements are consistent across trials. The first and second statistical analyses investigated the pharyngeal pressure and UES relaxation onsets and durations, respectively. Both analyses identified a significant interaction of swallow type (i.e., effortful vs. normal) by manometric sensor location (p<0.05). Across normal and effortful swallows, UES relaxation preceded pharyngeal pressure onsets, yet the rate of change (or degree of delay) varied across the sensors. Furthermore, the effortful swallow elicited longer pharyngeal pressure and UES relaxation durations, yet the pressure duration measured in the upper pharynx was significantly longer than that measured lower in the pharynx. These findings offer insight as to the potential positive and negative influence of the effortful swallow on pharyngeal timing.

The purpose of this research was to ascertain whether the existence of swallowing apnea (SA) was the sole result of glottic closure or the result of its own neural mechanism. Forty individuals served as participants. Groups 1 and 2 consisted of 10 individuals with laryngectomy less than one year and 10 individuals greater than one year, respectively. Groups 3 and 4 comprised 20 individuals who were age- and gender-matched to Groups 1 and 2. SA duration (SAD) was acquired during saliva swallows and 10-, 15-, 20-, and 25-ml water boluses. A repeated measures ANOVA was performed to determine mean differences in SAD as a function of group and bolus volume. Significant main effects of group and bolus volume were found and a significant interaction of group x bolus volume was found. In post-hoc analyses, both groups with laryngectomy exhibited statistically longer SADs than control groups. In single-df comparisons, the laryngectomy group over one year exhibited significantly shorter SADs on smaller versus larger bolus volumes. Even though SA is theoretically no longer needed in individuals with laryngectomy, the presence of SA remained in both groups with laryngectomy. Thus, these results support the hypothesis that SA is the result of its own neural command.