The Effects of Aspiration Status, Liquid Type, and Bolus Volume on Pharyngeal Peak Pressure in Healthy Older Adults

Abstract

The reasons for aspiration in healthy adults remain unknown. Given that the pharyngeal phase of swallowing is a key component of the safe swallow, it was hypothesized that healthy older adults who aspirate are likely to generate less pharyngeal peak pressures when swallowing. Accordingly, pharyngeal and upper esophageal sphincter pressures were examined as a function of aspiration status (i.e., nonaspirator vs. aspirator), sensor location (upper vs. lower pharynx), liquid type (i.e., water vs. milk), and volume (i.e., 5 vs. 10 ml) in healthy older adults. Manometric measurements were acquired with a 2.1-mm catheter during flexible endoscopic evaluation. Participants (N = 19, mean age = 79.2 years) contributed 28 swallows; during 8 swallows, simultaneous manometric measurements of upper and lower pharyngeal and upper esophageal pressures were obtained. Pharyngeal manometric peak pressure was significantly less for aspirators (mean = 82, SD = 31 mmHg) than for nonaspirators (mean = 112, SD = 20 mmHg), and upper pharyngeal pressures (mean = 85, SD = 32 mmHg) generated less pressure than lower pharyngeal pressures (mean = 116, SD = 38 mmHg). Manometric measurements vary with respect to aspiration status and sensor location. Lower pharyngeal pressures in healthy older adults may predispose them to aspiration.

Estudo da associação entre doenças crônicas naturais do envelhecimento e alterações da deglutição referidas por idosos da comunidade

“…The throat clearing can also be a result of esophageal changes such as gastro esophageal reflux, commonly found among elderly (30) . Compared to the young, the elderly have a higher pharyngeal transit time and transit time of opening of the cervical esophagus (3,4,11) . Such facts increases the chance of occurrence of laryngeal penetration and, consequently, tracheal aspiration, even after swallowing (3,4) .…”

“…Such factors contribute to the decrease of the masticatory force, formulation and propulsion of the food bolus. We can also, decreased muscle tone of the pharynx, reduced sensory response pharyngolaryngeal and decrease in elevation and foregoing the larynx, requiring a greater number of swallows for efficient cleaning of the pharynx and causing the penetration or laryngeal suction (3,4,5) . The signs most commonly related to changes in the mechanism of swallowing are the stasis, penetrations and laryngeal aspirations.…”

“…The aging process also involves changes in swallowing (2,3,4,5) , involving different systems -musculoskeletal, neuromuscular, dental, sensory -in addition to the side effects of drug treatments. Thus, the changes observed are tooth loss, atrophy of dental alveolus, presence of dental prosthesis, often ell-adapted, increase in adipose and connective tissue of tongue, salivary flow reduction and changes in the sensory system, which, in turn, cause decrease of taste (2) .…”

Alimentos na consistência líquida e deglutição: uma revisão crítica da literatura

“…Several authors (10) investigated the pharyngeal and upper esophageal sphincter pressures during liquid swallowing. Nineteen elderly people participated in the research, of which there were nine men and ten women who did not have swallowing complaints, neurological changes, gastroesophageal reflux, complaints of dysphonia, or otorhinolaryngologic diseases.…”

Características supraglóticas de idosos: relações com a função de deglutição

“…Estas modificações promovem alterações estruturais e funcionais, como rebaixamento do osso hioide (FENG et al, 2014), aumento dos tecidos conjuntivo e adiposo da língua, atrofia dos músculos da língua (FENG et al, 2013), aumento do tempo de trânsito oral (LOGEMANN, 2014), redução da sensibilidade laríngea (JAFARI et al, 2003;HUMBERT et al, 2009;MILLER, 2010;LOGEMANN et al, 2013), aumento do tempo para eliciar a resposta faríngea da deglutição (LOGEMANN, 2007;NEY et al, 2009;DANTAS et al, 2010;YABUNAKA et al, 2011;WANG et al, 2015) e do seu tempo de duração (KUROSU; LOGEMANN, 2010;IM et al, 2012), além da ocorrência de resíduos em valéculas, seios piriformes, escape posterior prematuro (ROBBINS et al, 1992;JAFARI et al, 2003;TANURE et al, 2005), latência entre o onset da subida do osso hioide e o onset da abertura do esfíncter esofágico superior (MENDEL; LOGEMAN, 2007), aumento do tempo de apneia de deglutição (LESLIE et al, 2005;KUROSU;LOGEMANN, 2010;WANG et al, 2015), menor excursão hiolaríngea, maior ocorrência de penetração laríngea e de tosse a partir dos 50 anos (JAFARI et al, 2003;DAGGET et al, 2006;SUZUKI et al, 2006;LOGEMANN et al, 2013) e até ocorrência de aspiração laringotraqueal em sujeitos saudáveis (ROBBINS et al, 1999;BUTLER et al, 2009;BUTLER et al, 2011). Essas alterações podem gerar modificações inadequadas na dieta, menor ingestão alimentar, desnutrição, desidratação, complicações pulmonares, isolamento social, ansiedade e até depressão (NEY et al, 2009).…”