Timing of Events in Normal Swallowing: A Videofluoroscopic Study

Abstract

Dynamic videofluoroscopic swallow studies were performed on 60 normal adult volunteers to establish normative data for clinically useful timing measures. The relation of swallowing gesture timing to the timing of actual bolus transit was of particular interest because it provides insight into the physiology of larger bolus volume accommodation. Parameters evaluated include the timing of bolus pharyngeal transit, soft palate elevation, aryepiglottic fold elevation and supraglottic closure, arrival of the bolus in the vallecula, hyoid bone displacement onset and duration, arrival of the bolus at the pharyngoesophageal sphincter, maximum pharyngeal constriction, and pharyngoesophageal sphincter opening. These parameters represent events required for normal deglutition, can be used to identify abnormalities in dysphagic patients, and provide a basis for comparison of swallowing performance both within and between patients. In addition, our experience has shown them to be reliably obtained. Other investigators have reported some of the measurements. However, to our knowledge, normative data for timing of aryepiglottic fold elevation, soft palate elevation and closure, and maximum pharyngeal constriction have not been described. Other measures included in the present study may provide alternatives when conventional measures cannot be obtained in selected patients. The relevance and clinical utility of new and alternative measures, in particular, are discussed.

The influence of sour taste and cold temperature in pharyngeal transit duration in patients with stroke

“…Despite this, it seems that previous investigations, as well as our own study, have detected shorter pharyngeal transit time with such stimulation, and therefore a positive effect on the pharyngeal response (5,17,27) . The stimuli were presented to each subject in a nonrandomized sequence to presume sour stimuli may improve swallowing (27) .…”

“…The average time of the pharyngeal phase swallowing in healthy patients is of about 1 second or less (17,21) . The impairment in pharyngeal transit time was expected in the volunteers of this study, due to their compromised swallowing, defined as neurogenic oropharyngeal dysphagia.…”

“…Through videofluoroscopic images, the beginning of the pharyngeal phase swallowing was considered to be the moment when the food bolus reached the posterior part of the nasal spine, located at the end part of the hard palate, at the beginning of the soft palate. The end of the pharyngeal phase swallowing was considered the moment when the bolus passed the upper esophagus sphincter (17) .…”

Protocolo para controle de eficácia terapêutica em disfagia orofaríngea neurogênica (PROCEDON)

“…No nal da década de 80 os critérios de e cá-cia utilizados na reabilitação da disfagia ainda não haviam sido satisfatoriamente delineados, sendo que as di culdades de pesquisa nesta área também estavam relacionadas à ausência de consenso sobre os critérios que deveriam mensurar a e cácia da reabilitação na disfagia orofaríngea [3][4][5] . Dentre esses critérios para mensurar a e cácia da reabilitação em disfagia orofaríngea foram descritos procedimentos que auxiliariam este controle, como a avaliação objetiva da deglutição, escalas de grau de comprometimento da disfagia orofarín-gea [6][7][8][9][10][11][12] e mais recentemente escalas funcionais de controle de ingestão oral 13 e o uso de software para medir tempo de trânsito orofaríngeo 14,15 , inclusive pós-fonoterapia 16 .…”

Análise quantitativa do sinal da deglutição

“…O emprego de softwares permite uma análise quantitativa como, por exemplo, a medição do tempo do trânsito do bolo alimentar pelas fases da deglutição (KENDALL et al, 2000;SPADOTTO et al, 2006).…”