The Effect of Voluntary Pharyngeal Swallowing Maneuvers on Esophageal Swallowing Physiology

Abstract

The purpose of our study was to evaluate whether swallowing maneuvers designed to impact pharyngeal physiology would also impact esophageal physiology. Healthy volunteers underwent high-resolution manometry while performing three randomized swallowing maneuvers with and without a 5-ml bolus: normal swallowing, Mendelsohn maneuver, and effortful swallowing. We examined esophageal parameters of peristaltic swallows, hypotensive or failed swallows ("nonperistaltic swallows"), distal contractile integral (DCI), contractile front velocity (CFV), intrabolus pressure, and transition zone (TZ) defect. Four females and six males (median age 39 years; range 25-53) were included in the study. The overall number of nonperistaltic swallows was 21/40 (53 %) during normal swallowing, 27/40 (66 %) during the Mendelsohn maneuver, and 13/40 (33 %) during effortful swallowing. There were significantly more overall nonperistaltic swallows with the Mendelsohn maneuver compared with effortful swallowing (p = 0.003). While swallowing a 5-ml bolus, there were more nonperistaltic swallows during the Mendelsohn maneuver (12/20, 60 %) compared to that during normal swallowing (6/20, 30 %) (p = 0.05) and more peristaltic swallows during effortful swallowing as compared to Mendelsohn maneuver (p = 0.003). Intrabolus esophageal pressure was greater during the Mendelsohn maneuver swallows in the bolus-swallowing condition as compared to normal swallowing (p = 0.02). There was no statistical difference in DCI, CFV, or TZ defect between swallowing conditions. The Mendelsohn maneuver may result in decreased esophageal peristalsis while effortful swallowing may improve esophageal peristalsis. Because it is important to understand the implications for the entire swallowing mechanism when considering retraining techniques for our patients, further investigation is warranted.

Effect of topical nasal anesthetic on swallowing in healthy adults: A double‐blind, high‐resolution manometry study

“…It is postulated that the reduction in sensory feedback due to TNA may reduce the magnitude of pharyngeal pressure applied. These results challenge the commonly held belief that “mechanoreceptors in the pharynx (deep to the mucosa) are largely responsible for modulating swallowing physiology, and these fibers were probably not affected by our topical anesthetic.” (p375) Research with larger diameter catheters report the use of additional oral (gargled) applications of anesthetic, which may affect sensorimotor function to a greater degree. Replication of these results with a larger diameter HRM catheter, which may lead to greater discomfort in nonanaesthetized conditions, is indicated to further explore the impact of TNA on oropharyngeal sensorimotor function.…”

“…However, it is unknown if desensitizing nasal mucosa affects sensorimotor aspects of swallowing. This is critical because the majority of studies investigating pharyngeal swallowing with HRM utilize TNA prior to catheter insertion . The most commonly provided TNA is a 2% viscous lidocaine hydrochloride solution.…”

“…The most commonly provided TNA is a 2% viscous lidocaine hydrochloride solution. Some studies administer a secondary anesthetic that is sprayed or gargled intraorally, or directly applied to the catheter …”

Expanding Instrumental Options for Dysphagia Diagnosis and Research: Ultrasound and Manometry

“…Pharyngeal HRM is limited by a seldom-reported measurement error in the ManoScan™ system, used widely in research [52,73,81,82,88,92,93,94,95]. A pressure drift has been found to refute the manufacturer's report that pressure uniformity remains within 2 mm Hg for 4 h or less of recording [93,96].…”

A framework for understanding shared substrates of airway protection

“…The modulation of swallowing is routinely used in the rehabilitation of dysphagia 79,80,111 . Treatment paradigms such as the supraglottic swallow, effortful swallow, and Mendelsohn maneuver require that volitional control is exerted over motor output, changing some physiological aspects of the resulting swallow.…”