Quantitative Assessment of Pharyngeal Bolus Driving Forces

Abstract

This study analyzes the differences between wet and dry swallows; a manofluorogram is used to determine forces that affect pharyngeal bolus flow. By defining bolus pressures, many of the limitations of pharyngeal manometry are surmounted. This makes manometry a more useful clinical tool. The study results indicate that only a small portion of pharyngeal-generated pressure is directly applied to the bolus. The manofluorogram demonstrates that bolus transit relies on the synergistic action of two pumps--the oropharyngeal propulsion pump and the hypopharyngeal suction pump. A technique is illustrated for quantifying the forces that affect bolus flow. Quantification of force can differentiate abnormal forces responsible for lingual, pharyngeal, and hypopharyngeal pathology in dysphagic patients. The degrees of impairment can be measured.

Food Measures and Other Critical Diagnostic Measures

“…In the past two decades, the physiology of oropharyngeal swallowing has been extensively investigated by a number of researchers with the use of various instrumental procedures [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. These research and clinical studies have attempted quantitative assessment of swallowing and contributed greatly to our understanding of the dynamics of human deglutition.…”

“…During these stages, certain physiologic components take place for the clearance of the bolus from the oral cavity and pharynx without residue and/or aspiration. These components include: (1) propulsion of the bolus from the oral cavity into the pharynx; (2) velopharyngeal closure; (3) tongue base and posterior pharyngeal wall contact; (4) laryngeal closure; (5) hyolaryngeal elevation accomplished by upward and forward movement of the hyoid bone and the larynx, and (6) upper esophageal sphincter (UES) opening. These components are important to carry the bolus through the pharynx with adequate propulsive force and airway protection [18].…”

“…the characteristics of the bolus [1,2,8,[38][39][40][41][42][43][44][45][46][47][48]. The changes include duration of events, extent of structural movements, and coordination of events.…”

“…These techniques include: videofluorography [2,4]; endoscopy [9]; ultrasound [15,16,19]; manometry [1][2][3]; electromyography [2,17,47]; electroglottography [10]; scintigraphy [6]; auscultation [7]; CT [5]; MRI [23], and others [20,22]. The combination of two or more techniques, often procedures with images and without images, is also implemented [1,2,8,11,17].…”

Swallow and breathing coordination following suprahyoid muscle injury.

“…Schluckatmung activity can be distinguished from gradual onset and offset of the eupneic rhythmic breathing, which is 9 normal breathing pattern. The schluckatmung is believed to aid in deglutition by producing increasing inspiratory drive, resulting in negative transdiaphragmatic pressure as determined by multiple studies based on manometric pressure patterns and videofluoroscopy data (Cerenko, McConnel, & Jackson, 1989;McConnel, 1988;McConnel, Cerenko, & Mendelsohn, 1988;McConnel, Guffin, & Cerenko, 1991;McConnel, Guffin, Cerenko, & Ko, 1992). This negative pressure likely helps propel the bolus through the alimentary tract during the transition from pharyngeal and esophageal phases of swallowing (McConnel et al, 1991).…”