The Mechanism of the Larynx—II The epiglottis and closure of the larynx

Ardran, G. M.; Kemp, F. H.

doi:10.1259/0007-1285-40-473-372

Cited by 71 publications

(34 citation statements)

References 10 publications

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“…To prevent aspiration during swallowing, the true vocal folds close leading to adduction of the false vocal folds and aryepiglottic folds, and subsequently retroversion of the epiglottis. 15 All of these areas, baring the true vocal folds, which were only severely edematous in only 1.9% of patients, showed a correlation to VHNSS questions.…”

Section: Discussionmentioning

confidence: 90%

Internal Lymphedema Correlates with Subjective and Objective Measures of Dysphagia in Head and Neck Cancer Patients

Jackson

Ridner

Deng

et al. 2016

Journal of Palliative Medicine

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Background: Tumor/treatment-related internal lymphedema (IL) and/or external lymphedema (EL) are associated with functional deficits and increased symptom burden in head and neck cancer patients (HNCP). Previously, we noted association between EL/IL and patient-reported dysphagia using the Vanderbilt Head and Neck Symptom Survey (VHNSS) version 1.0. Objective: To determine the relationship between IL/EL and subjective and objective measures of swallowing function. Methods: Eighty-one HNCP completed: (1) VHNSS version 2.0, including 13 swallowing/nutrition-related questions grouped into three clusters: swallow solids (ss), swallow liquids (sl), and nutrition(nt); (2) physical assessment of EL using Foldi scale; (3) endoscopic assessment of IL using Patterson scale (n = 56); and (4) modified barium swallow study rated by dysphagia outcome and severity scale (DOSS) and in conjunction with a swallow evaluation by National Outcomes Measurement System (NOMS). Examinations were performed at varied time points to assess lymphedema spectrum, from baseline (n = 15, 18.1%) to 18 months post-therapy (n = 20, 24.1%). Results: VHNSS swallow/nutrition items scores correlated with NOMS/DOSS ratings ( p < 0.001). Highest correlation was with NOMS: ss (-0.73); sl (-0.61); nt (-0.56). VHNSS swallow/nutrition scores correlated with maximum grade of swelling for any single structure on Patterson scale: ss (0.43; p = 0.001); sl (0.38; p = 0.004); nt (0.41; p = 0.002). IL of aryepiglottic/pharyngoepiglottic folds, epiglottis, and pyriform sinus were most strongly correlated with VHNSS and NOMS ratings. NOMS/DOSS ratings correlated with EL (> = -0.34; p < 0.01). No meaningful correlations exist between VHNSS swallow/nutrition items and EL (< -0.15, p > 0.20). Conclusions: IL correlated with subjective and objective measures of swallow dysfunction. Longitudinal analysis of trajectory and impact of IL/EL on dysphagia is ongoing.

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Section: Discussionmentioning

confidence: 90%

Internal Lymphedema Correlates with Subjective and Objective Measures of Dysphagia in Head and Neck Cancer Patients

Jackson

Ridner

Deng

et al. 2016

Journal of Palliative Medicine

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“…The importance of laryngeal valving during deglutition and its relevance to airway protection have long been recognized and studied [10][11][12][13][14][15][16][26][27][28][29][30]. Patients with surgical ablation or denervation of one or all laryngeal valves may demonstrate some degree of laryngeal penetration of ingested material with or without subsequent aspiration [17,31,32].…”

Section: Discussionmentioning

confidence: 99%

“…According to Ardran and Kemp [12], anterior arytenoid tilting combined with laryngeal elevation appears to be the main safeguard against penetration of swallowed material into the laryngeal inlet. We were able to simulate this protective anterior arytenoid tilting behavior consistently in four subjects (subjects 1, 2, 4, and Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…The respiratory system accommodates swallowing by momentarily relinquishing its ventilatory role when the upper airway is closed at the larynx. Laryngeal closure during swallowing has been characterized as a series of approximating valves that include the epiglottis and aryepiglottic folds, arytenoid cartilages, ventricular or false vocal folds (FVFs), and true vocal folds (TVFs) [10][11][12][13][14][15][16].…”

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confidence: 99%

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

et al. 1993

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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.

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“…It commonly occurs in a mild form in individuals with oropharyngeal problems. While we know the physiological mechanisms that prevent aspiration of food into the respiratory tract (Ardran and Kemp 1967), little is known about how we avoid swallowing air. Observations of videoflouroscopies during feeding indicate that the pharynx is expanded while breathing occurs, due to the action of the stylopharyngeus muscle.…”

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confidence: 99%

Air swallowing in Rett syndrome

Morton

Pinnington

Ellis

2000

Develop Med Child Neuro

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The possible causes of excessive swallowing of air leading to bloating, which is common in Rett syndrome (RS), were investigated during feeding and at rest. Seven individuals with RS aged between 4 and 33 years (three with air bloat) underwent feeding videoflouroscopy and concurrent respiration monitoring. The results were compared with a randomly selected group of 11 individuals, aged between 2 and 16 years, with quadriplegic cerebral palsy and feeding problems, some of whom had mild air bloat. All individuals from both groups had isolated pharyngeal swallows and several mouth breathed; this may account for some air swallowing but not the severe air bloat characteristic of RS. Thirty‐three individuals with RS aged between 3 and 44 years were monitored for nasal respiration, chest movements, swallowing, and vocal cord position at rest (between feeding). Twenty had air bloat, 17 of whom swallowed air during breath‐holding in the same way, and three gulped air during hyperventilation. Of the 13 without air bloat, eight did not have recurrent breath‐holding and five did, but without concurrent air swallowing. Several methods for reducing air swallowing in apnoea were investigated. The most successful was a dummy with an air leak, but this was poorly tolerated and could only be used for short periods of time. Apnoeas and air bloat are often worse when individuals are distressed and may in some individuals be reduced by anxiolytic medications.

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The Mechanism of the Larynx—II The epiglottis and closure of the larynx

Cited by 71 publications

References 10 publications

Internal Lymphedema Correlates with Subjective and Objective Measures of Dysphagia in Head and Neck Cancer Patients

Internal Lymphedema Correlates with Subjective and Objective Measures of Dysphagia in Head and Neck Cancer Patients

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

Air swallowing in Rett syndrome

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