Swallow Event Sequencing: Comparing Healthy Older and Younger Adults

Abstract

Previous research has established that a great deal of variation exists in the temporal sequence of swallowing events for healthy adults. Yet, the impact of aging on swallow event sequence is not well understood. Kendall et al. (Dysphagia 18(2):85-91, 2003) suggested there are 4 obligatory paired-event sequences in swallowing. We directly compared adherence to these sequences, as well as event latencies, and quantified the percentage of unique sequences in two samples of healthy adults: young (< 45) and old (> 65). The 8 swallowing events that contribute to the sequences were reliably identified from videofluoroscopy in a sample of 23 healthy seniors (10 male, mean age 74.7) and 20 healthy young adults (10 male, mean age 31.5) with no evidence of penetration-aspiration or post-swallow residue. Chi-square analyses compared the proportions of obligatory pairs and unique sequences by age group. Compared to the older subjects, younger subjects had significantly lower adherence to two obligatory sequences: Upper Esophageal Sphincter (UES) opening occurs before (or simultaneous with) the bolus arriving at the UES and UES maximum distention occurs before maximum pharyngeal constriction. The associated latencies were significantly different between age groups as well. Further, significantly fewer unique swallow sequences were observed in the older group (61%) compared with the young (82%) (χ = 31.8; p < 0.001). Our findings suggest that paired swallow event sequences may not be robust across the age continuum and that variation in swallow sequences appears to decrease with aging. These findings provide normative references for comparisons to older individuals with dysphagia.

Reference Values for Healthy Swallowing Across the Range From Thin to Extremely Thick Liquids

“…The expected sequence to which paired event patterns were compared was BPM < HYB < UESO < UESMax < MPC < UESC. In contrast with previous literature (Herzberg, Lazarus, Steele, & Molfenter, 2018; Kendall, Leonard, & McKenzie, 2003; Kendall, McKenzie, Leonard, Gonçalves, & Walker, 2000; Molfenter, Leigh, & Steele, 2014), this sequence was selected because it emphasizes gestural rather than bolus events and focuses exclusively on pharyngeal and UES events rather than laryngeal events. As noted above, the timings of LVC onset and LVCOff were found to be tightly associated with UESO and UES closing, respectively.…”

“…The sequence of pharyngeal events is stable and proceeds in the majority of cases as follows: BPM < HYB < UESO < UESMax < MPC < UESC. The subsequences of UESO < UESMax and UESMax < UESC have previously been described as obligatory sequences in the literature (Herzberg et al, 2018; Kendall et al, 2003; Molfenter et al, 2014).…”

The Effect of Chin-Down Position and Bolus Volume on Swallow-Induced Respiratory Measures in Young Healthy Adults

“…Similarly, swallow sound has been correlated in time with passage of bolus through the hypo-pharynx, including pyriform sinus and upper oesophageal sphincter (UES) [1,44]. Passage of bolus through the UES marks the end of oro-pharyngeal swallowing followed by return of pharyngeal structures to its resting position [45,46]. The interval between EMG and apnoea onset during thin-liquid swallows, therefore, could be approximated to the oral transit time (OTT) and between onset of apnoea and offset of swallow sound to pharyngeal transit time (PTT).…”

Deglutição no envelhecimento e a odontologia

“…Nos idosos, ocorre o enfraquecimento da coordenação entre as fases da deglutição. Em jovens, as fases estão intimamente ligadas e muitas vezes se sobrepõem, atuando de forma protetiva 17 . Por meio da videofluoroscopia da deglutição, podem-se observar atraso de 0,4 segundos para o estímulo da fase faríngea, diminuição do tempo de duração total do reflexo faríngeo e diminuição da duração de abertura cricofaríngea para 0,25 segundos.…”