Esophago/Pharyngo/Laryngeal Interrelationships: Airway protection mechanisms

Kidder, Thomas M.

doi:10.1007/bf00431414

Cited by 17 publications

(11 citation statements)

References 18 publications

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“…Both swallowing and coughing reflexes are important airway protective mechanisms that clears the larynx and upper airways of excessive saliva and secretions and/or foreign matters (1, 2). Swallowing has the most important reflex that prevents secretion or foreign matters from entering the airways (1).…”

Section: Introductionmentioning

confidence: 99%

Accumulated oropharyngeal water increases coughing during dental treatment with intravenous sedation

Kohjitani

Egusa

Shimada

et al. 2007

J of Oral Rehabilitation

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In dental procedures performed under intravenous sedation in patients with intellectual disabilities, procedures are sometimes interrupted by the cough reflex, which may be triggered by intraoral use of water and/or increased secretion stimulating the pharyngeal/laryngeal mucosa, or by those irritating the tracheal mucosa directly through anesthetics-induced impairment of the laryngeal closure reflex. We investigated relationships between frequency of coughing episodes and intraoral use of water, water remaining in the oropharyngeal space, and mean infusion rate of propofol during dental treatments performed under intravenous sedation with midazolam and propofol. Twenty-one intellectually disabled patients were enrolled. After induction, a 14 Fr. suction catheter was inserted nasally, which was fixed where oropharyngeal suction could be done most effectively. Patients were divided into three groups according to the amount of intraoral use of water, amount of oropharyngeal suction and mean infusion rate of propofol. The amount of oropharyngeal suction significantly correlated with intraoral use of water. Frequency of coughing episodes significantly correlated with amount of oropharyngeal suction per minute. However, coughing episodes correlated neither with intraoral use of water nor with infusion rate of propofol. These findings suggested that accumulation of water in the oropharynx increased vulnerability to the cough reflex in dental treatments performed under intravenous sedation.

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Section: Introductionmentioning

confidence: 99%

Accumulated oropharyngeal water increases coughing during dental treatment with intravenous sedation

Kohjitani

Egusa

Shimada

et al. 2007

J of Oral Rehabilitation

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“…For that matter, it has been recognized that pneumonia is more probably due to malnutrition, dehydration, and reduced immune system defense as a result of impaired swallowing (1, 6–8). It is, therefore, probably not surprising that those of our patients who were able to use the stimulator during their meals at home did better than during fluoroscopy since the radiological setting does not mimic normal eating (5, 17). …”

Section: Discussionmentioning

confidence: 89%

“…Sphincteric vocal fold closure is the most important safety mechanism in preventing aspiration (5) and controls the “final” expression of any disrupted swallow at the glottic endpoint, regardless of the level and degree of failure involved along the swallowing cascade.…”

Section: Introductionmentioning

confidence: 99%

Paced Glottic Closure for Controlling Aspiration Pneumonia in Patients with Neurologic Deficits of Various Causes

Broniatowski

Moore

Grundfest‐Broniatowski

et al. 2010

Ann Otol Rhinol Laryngol

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Purpose of the study To determine whether paced vocal fold adduction can check aspiration in patients with various neurological conditions. Design and method of study and analysis Five patients with fluoroscopically documented aspiration and repeated pneumonias were enrolled. Two previously reported patients with hemispheric stroke* were compared to three additional subjects with brainstem-basal ganglia and cerebellar stroke (BSBGC), cerebral palsy (CP) and multiple sclerosis (MS). A modified Finetech-Brindey stimulator was implanted subcutaneously and linked to the ipsilateral recurrent laryngeal nerve via perineural electrodes. Vocal fold adduction and glottic closure were effected with pulse trains (42 Hz, 1.2 mA, 188–560 μsec) and recorded with Enhanced Image J ®. Fluoroscopy results with and without stimulation were assessed by two independent blinded reviewers. Pneumonia rates were compared before, after and during the 6–12 months enrollment periods. Summary of results There was statistically significant vocal fold adduction (p < .05) for all patients, further verified with bolus arrest (p < .05 for thin, thick liquids and puree depending on the speech-language pathologist). Pneumonia was prevented in four of the five patients during enrollment. The fifth patient with BSBGC was unable to completely seal the glottis and open the cricopharyngeus enough to handle his secretions. Conclusions Vocal fold pacing for aspiration pneumonia from a variety of neurological insults appears appropriate as long as the glottis can be sealed. It is not sufficient when the cricopharyngeus must be independently opened.

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“…Moreover, reflex coughing during dental treatment also requires attention in patients with swallowing disabilities due to other reasons. Although cough is an important reflex to prevent aspiration , a coughing episode during dental treatment is not generally desirable because it interrupts the dental procedure and leads to sudden body movement, which may result in oral tissue damage from dental instruments. Additionally, it is difficult for a dentist to predict the attack of coughing during dental treatment.…”

Section: Introductionmentioning

confidence: 99%

Both head extension and mouth opening impair the ability to swallow in the supine position

Hanamoto

Kadono

Sato

et al. 2014

J of Oral Rehabilitation

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Head position and mouth opening in the supine position may impair the ability to swallow. If this does occur, it would lead to retention of intra-oral fluids during dental treatment, which would lead to stimulation of the cough reflex. This study was conducted to investigate how head position and mouth opening affect swallowing ability. The water swallowing test was performed in 13 healthy adult subjects in the supine position. The subjects were asked to swallow 10 mL of water that was injected into the mouth in a single attempt. After swallowing, the residual intra-oral water was suctioned and its volume was measured. An electromyogram (EMG) of the suprahyoid (SH) muscles was also recorded during the test. The duration of SH muscle activity and peak amplitude of SH EMG were examined. The water swallowing test was performed under three head positions (neutral, extended and flexed) and four mouth opening patterns (interincisal distances of 0, 20, 30 and 40 mm). The wider the subject opened the mouth, the more the water remained in the mouth after swallowing. The residual volume of water was more in the extended position compared with that in the neutral and flexed positions. Peak amplitude of SH EMG decreased with mouth opening. Duration of SH muscle activity was longer in the extended position than in the neutral and flexed positions. Head extension and mouth opening can induce difficulty in swallowing in the supine position by extending the duration of SH muscle activity while reducing its intensity.

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Esophago/Pharyngo/Laryngeal Interrelationships: Airway protection mechanisms

Cited by 17 publications

References 18 publications

Accumulated oropharyngeal water increases coughing during dental treatment with intravenous sedation

Accumulated oropharyngeal water increases coughing during dental treatment with intravenous sedation

Paced Glottic Closure for Controlling Aspiration Pneumonia in Patients with Neurologic Deficits of Various Causes

Both head extension and mouth opening impair the ability to swallow in the supine position

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