Normal laryngeal valving patterns during three breath-hold maneuvers: A pilot investigation

Abstract

Synchronized videonasendoscopy and respiratory recordings were conducted in six healthy male subjects to evaluate activity of the arytenoid cartilages, true vocal folds, false vocal folds, and epiglottis during repeated trials of three breath-hold maneuvers: EASY hold, INHALE HARD hold, and INHALE/EXHALE HARD hold. Five of the six subjects demonstrated maximal laryngeal valving on the HARD breath-hold conditions. One subject showed maximal laryngeal valving on the EASY hold condition, and rarely demonstrated any medial displacement or contact of the laryngeal valves on either effortful breath-hold maneuver. Arytenoid approximation and true vocal fold closure were produced consistently by the majority of subjects on all breath-hold maneuvers, but false vocal fold approximation and anterior arytenoid tilting were accomplished by the majority of subjects only during the effortful breath-hold conditions. Intratrial and intersubject variation indicated that presence or degree of laryngeal valving cannot be assumed during a breath-hold maneuver. We conclude that videonasendoscopy has merit in assessing a patient's laryngeal valving ability and progress in effectively using a breath-hold maneuver for safe swallowing function.

Effects of Voluntary Maneuvers on Tongue Base Function for Swallowing

“…There are two known swallow maneuvers designed to improve tongue base posterior mo-Lazarus/Logemann/Song/Rademaker/ Kahrilas tion and/or anterior motion of the posterior pharyngeal wall during swallowing, including the effortful swallow and the tongue-hold maneuver [4]. Two other swallow maneuvers, the supersupraglottic swallow and the Mendelsohn maneuver, are designed to improve airway closure and laryngeal elevation, respectively, during the swallow [5][6][7]. A fair amount of effort is typically exerted when performing the latter two maneuvers, with anticipated improvement sometimes observed in other aspects of the pharyngeal swallow [5].…”

Dysphagia Management in Stroke Rehabilitation

“…The supraglottic swallow provides airway protection at the level of the true vocal folds, while the super-supraglottic swallow provides airway protection at the level of the laryngeal vestibule. Breath-holding strategies were initially designed for patient's status post head and neck surgery [7,47,48]. The use has been broadened to other patient populations demonstrating airway invasion before or during the swallow [13]; however, research has identified increased cardiovascular risk when using either breath-holding techniques for individuals with dysphagia following stroke [49].…”

Behavioral Management for Oropharyngeal Dysphagia

“…Instructions for the supraglottic swallow are [38,39] The super-supraglottic swallow is designed to close the airway entrance before and during the swallow [1,38,39]. The instructions for the super-supraglottic swallow are:…”

“…The supraglottic swallow is designed to close the airway at the level of the true vocal folds before and during the swallow [1,4,38]. Instructions for the supraglottic swallow are [38,39] The super-supraglottic swallow is designed to close the airway entrance before and during the swallow [1,38,39].…”