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01-09-2009 | Original Article

Effects of Oropharyngeal Air-Pulse Stimulation on Swallowing in Healthy Older Adults

Authors: Julie A. Theurer, Kathy A. Czachorowski, Lyndsay P. Martin, Ruth E. Martin

Published in: Dysphagia | Issue 3/2009

Abstract

While previous research has shown that air-pulse stimulation of the oropharynx facilitates saliva swallowing in young adults, the effects of air pulses in older adults have not been examined. Responses to air-pulse stimulation may differ in young and older adults given age-related changes in sensation, swallowing physiology, and swallow-related brain activation. Therefore, this study sought to determine the effects of oropharyngeal air-pulse stimulation on saliva swallowing rates in 18 healthy older adults. Saliva swallowing rates were monitored across six conditions: baseline without mouthpiece, baseline with mouthpiece in situ, unilateral right oropharyngeal stimulation, unilateral left oropharyngeal stimulation, bilateral oropharyngeal stimulation, and sham stimulation. Results indicated that bilateral oropharyngeal air-pulse stimulation was associated with a statistically significant increase in mean saliva swallowing rate compared to baseline without mouthpiece, baseline with mouthpiece in situ, and sham stimulation. In previous studies, young adults reported an irrepressible urge to swallow in response to oropharyngeal air-pulse delivery, but the older adults in the current study did not perceive the air-pulse stimulation as being associated with swallowing or other behaviors. These findings indicate that oropharyngeal air-pulse stimulation facilitates the elicitation of saliva swallowing in older adults.

Theurer JA, Bihari F, Barr AM, Martin RE. Oropharyngeal stimulation with air-pulse trains increases swallowing frequency in healthy adults. Dysphagia. 2005;20:254–60. doi:10.1007/s00455-005-0021-1.PubMedCrossRef

Lowell SY, Dietrich-Burns K, Griffith G, Knorr-Chung BR, Ludlow CL. Effects of oral-sensory and vibrotactile stimulation on swallowing in humans. Paper presented at 16th Annual Dysphagia Research Society Meeting, Wild Dunes, South Carolina, March 6–8, 2008.

Sörös P, Lalone E, Smith R, Stevens T, Theurer J, Menon RS, et al. Functional MRI of oropharyngeal air-pulse stimulation. Neuroscience. 2008;153:1300–8. doi:10.1016/j.neuroscience.2008.02.079.PubMedCrossRef

Lowell SY, Poletto CJ, Knorr-Chung BR, Reynolds RC, Simonyan K, Ludlow CL. Sensory stimulation activates both motor and sensory components of the swallowing system. Neuroimage. 2008;42:285–95. doi:10.1016/j.neuroimage.2008.04.234.PubMedCrossRef

Aviv J. Effects of aging on sensitivity of the pharyngeal and supraglottic areas. Am J Med. 1997;103:74S–6S. doi:10.1016/S0002-9343(97)00327-6.PubMedCrossRef

Tracy JF, Logemann JA, Kahrilas PJ, Jacob P, Kobara M, Krugler C. Preliminary observations on the effects of age on oropharyngeal deglutition. Dysphagia. 1989;4:90–4. doi:10.1007/BF02407151.PubMedCrossRef

Martin RE, Barr AM, MacIntosh BJ, Smith RC, Stevens TK, Taves D, et al. Cerebral cortical processing of swallowing in older adults. Exp Brain Res. 2007;176:12–22. doi:10.1007/s00221-006-0592-6.PubMedCrossRef

Logemann JA. Effects of aging on the swallowing mechanism. Otolaryngol Clin North Am. 1990;23:1045–56.PubMed

Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003;124:328–36. doi:10.1378/chest.124.1.328.PubMedCrossRef

10.

Sonies BC, Stone M, Shawker T. Speech and swallowing in the elderly. Gerodontology. 1984;3:115–23. doi:10.1111/j.1741-2358.1984.tb00362.x.PubMedCrossRef

11.

Kapila YV, Dodds WJ, Helm JF, Hogan WJ. Relationship between swallow rate and salivary flow. Dig Dis Sci. 1984;29:528–33. doi:10.1007/BF01296273.PubMedCrossRef

12.

Lagerlöf F, Dawes C. The volume of saliva in the mouth before and after swallowing. J Dent Res. 1984;63:618–21.PubMed

13.

Lear CSC, Flanagan JB Jr, Moorrees CFA. The frequency of deglutition in man. Arch Oral Biol. 1965;10:83–99. doi:10.1016/0003-9969(65)90060-9.PubMedCrossRef

14.

Rudney JD, Ji Z, Larson CJ. The prediction of saliva swallowing frequency in humans from estimates of salivary flow rate and the volume of saliva swallowed. Arch Oral Biol. 1995;40:507–12. doi:10.1016/0003-9969(95)00004-9.PubMedCrossRef

15.

Power ML, Fraser CH, Hobson A, Singh S, Tyrrell P, Nicholson DA, et al. Evaluating oral stimulation as a treatment for dysphagia after stroke. Dysphagia. 2006;21:49–55. doi:10.1007/s00455-005-9009-0.PubMedCrossRef

16.

Theurer JA, Czachorowski KA, Martin LP, Martin RE. Oropharyngeal sensory stimulation in healthy older adults. J Dent Res. 2008;87(B):545. www.dentalresearch.org.

17.

Martin RE, Bihari F, Theurer JA, Smith RC. U.S. Patent Application No. 20060282010. Washington, DC: U.S. Patent and Trademark Office.

18.

Logemann JA, Kahrilas PJ, Cheng J, Pauloski B, Gibbons PJ, Rademaker AW, et al. Closure mechanisms of laryngeal vestibule during swallowing. Am J Physiol. 1992;262:G338–44.PubMed

19.

Martin RE, Goodyear BG, Gati JS, Menon RS. Cerebral cortical representation of automatic and volitional swallowing in humans. J Neurophysiol. 2001;85:938–50.PubMed

20.

Navazesh M, Christensen CM. A comparison of whole mouth resting and stimulated salivary measurement procedures. J Dent Res. 1982;61:1158–62.PubMed

21.

Sonies BC. Oropharyngeal dysphagia in the elderly. Clin Geriatr Med. 1992;8:569–77.PubMed

22.

Aviv JE, Hecht C, Weinberg H, Dalton JF, Urken ML. Surface sensibility of the floor of the mouth and tongue in healthy controls and in radiated patients. Otolaryngol Head Neck Surg. 1992;107:418–23.PubMed

23.

Calhoun KH, Gibson B, Hartley L, Minton J, Hokanson JA. Age-related changes in oral sensation. Laryngoscope. 1992;102:109–16. doi:10.1288/00005537-199202000-00001.PubMedCrossRef

24.

Fucci D, Petrosino L, Robey RR. Auditory masking effects on lingual vibrotactile thresholds as a function of age. Percept Mot Skills. 1982;54:943–50.PubMed

25.

Fukunaga A, Uematsu H, Sugimoto K. Influences of aging on taste perception and oral somatic sensation. J Gerontol A Biol Sci Med Sci. 2005;60:109–13.PubMed

26.

Newman HF. Palatal sensitivity to touch correlation with age. J Am Geriatr Soc. 1975;27:319.

27.

Ostreicher HJ, Hawk AM. Patterns of performance for two age groups of normal adults on a test of oral form discrimination. J Commun Dis. 1982;15:329–35. doi:10.1016/0021-9924(82)90015-6.CrossRef

28.

Petrosino L, Fucci D, Robey RR. Changes in lingual sensitivity as a function of age and stimulus exposure time. Percept Mot Skills. 1982;55:1083–90.PubMed

29.

Weiffenbach JM, Tylenda CA, Baum BJ. Oral sensory changes in aging. J Gerontol. 1990;45:M121–5.PubMed

30.

Chamberlain CK, Cornell JE, Saunders MJ, Hatch JP, Shinkai RS, Yeh CK. Intra-oral tactile sensation and aging in a community-based population. Aging Clin Exp Res. 2007;19:85–90.PubMed

31.

Cook IJ, Weltman MD, Wallace K, Shaw DW, McKay E, Butler SP. Influence of aging on oral-pharyngeal bolus transit and clearance during swallowing: scintigraphic study. Am J Physiol. 1994;266:G972–7.PubMed

32.

Shaw DW, Cook IJ, Gabb M, Holloway RH, Simula ME, Panagopoulos V, et al. Influence of normal aging on oral-pharyngeal and upper esophageal sphincter function during swallowing. Am J Physiol. 1995;268:G389–96.PubMed

33.

Sonies BC, Parent LJ, Morrish K, Baum BJ. Durational aspects of the oral-pharyngeal phase of swallow in normal adults. Dysphagia. 1988;3:1–10. doi:10.1007/BF02406274.PubMedCrossRef

34.

Linden P, Tippett D, Johnston J, Siebens A, French J. Bolus position at swallow onset in normal adults: preliminary observations. Dysphagia. 1989;4:146–50. doi:10.1007/BF02408037.PubMedCrossRef

35.

Robbins J, Hamilton JW, Lof GL, Kempster GB. Oropharyngeal swallowing in normal adults of different ages. Gastroenterology. 1992;103:823–9.PubMed

36.

Ding R, Logemann J, Larson C, Rademaker A. The effects of taste and consistency on swallow physiology in younger and older healthy individuals: A surface electromyographic study. J Speech Lang Hear Res. 2003;46:977–89. doi:10.1044/1092-4388(2003/076).PubMedCrossRef

37.

Fulp SR, Dalton CB, Castell JA, Castell DO. Aging-related alterations in human upper esophageal sphincter function. Am J Gastroenterol. 1990;85:1569–72.PubMed

38.

McKee GJ, Johnston BT, McBride GB, Primrose WJ. Does age or sex affect pharyngeal swallowing? Clin Otolaryngol Allied Sci. 1998;23:100–6. doi:10.1046/j.1365-2273.1998.00100.x.PubMedCrossRef

39.

Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA, Kahrilas PJ, Smith CH. Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men. J Speech Lang Hear Res. 2000;43:1264–74.PubMed

40.

Stephen JR, Taves DH, Smith RC, Martin RE. Bolus location at the initiation of the pharyngeal stage of swallowing in healthy older adults. Dysphagia. 2005;20:266–72. doi:10.1007/s00455-005-0023-z.PubMedCrossRef

41.

Kern MK, Jaradeh S, Jesmanowicz A, Arndorfer RC, Shaker R. Cerebral cortical representation of reflexive and volitional swallowing in humans. Am J Physiol. 2001;280:G531–8.

42.

Mosier K, Patel R, Liu WC, Kalnin A, Maldjian J, Baredes S. Cortical representation of swallowing in normal adults: Functional implications. Laryngoscope. 1999;109:1417–23. doi:10.1097/00005537-199909000-00011.PubMedCrossRef

43.

Dubner R, Sessle BJ, Storey AT. The neural basis of oral and facial function. New York: Plenum Press; 1978.

44.

Miller AJ. The neuroscientific principles of swallowing and dysphagia. San Diego: Singular; 1999.

45.

Hamdy S, Aziz Q, Rothwell JC, Hobson A, Barlow J, Thompson DG. Cranial nerve modulation of human cortical swallowing motor pathways. Am J Physiol. 1997;272:G802–8.PubMed

46.

Ootani S, Umezaki T, Shin T, Murata Y. Coverage of afferents from the SLN and CPN in cat medullary swallowing neurons. Brain Res Bull. 1995;37:397–404. doi:10.1016/0361-9230(95)00018-6.PubMedCrossRef

47.

Sessle BJ. Excitatory and inhibitory inputs to single neurons in the solitary tract nucleus and adjacent reticular formation. Brain Res. 1973;53:319–31. doi:10.1016/0006-8993(73)90217-5.PubMedCrossRef

48.

Thexton AJ, Crompton AW. The control of swallowing. In: Linden RWA, editor. Frontiers of oral biology: vol. 9, the scientific basis of eating: taste and smell. Salivation, mastication and swallowing and their dysfunctions. Karger: Basel; 1998. p. 168–222.

49.

Disbrow EA, Hinkley LB, Roberts TP. Ipsilateral representation of oral structures in human anterior parietal somatosensory cortex and integration of inputs across the midline. J Comp Neurol. 2003;467:487–95. doi:10.1002/cne.10935.PubMedCrossRef

50.

Yoshida K, Maezawa H, Nagamine T, Fukuyama H, Murakami K, Iizuka T. Somatosensory evoked magnetic fields to air-puff stimulation on the soft palate. Neurosci Res. 2006;55:116–22. doi:10.1016/j.neures.2006.02.007.PubMedCrossRef

51.

Fabri M, Polonara G, Salvolini U, Manzoni T. Bilateral cortical representation of the trunk midline in human first somatic sensory area. Hum Brain Mapp. 2005;25:287–96. doi:10.1002/hbm.20099.PubMedCrossRef

52.

Hamdy S, Aziz Q, Rothwell JC, Singh KD, Barlow J, Hughes DG, et al. The cortical topography of human swallowing musculature in health and disease. Nat Med. 1996;2:1217–24. doi:10.1038/nm1196-1217.PubMedCrossRef

53.

Martin RE, MacIntosh BJ, Smith RC, Barr AM, Stevens TK, Gati JS, et al. Cerebral areas processing swallowing and tongue movements are overlapping but distinct: A functional magnetic resonance imaging study. J Neurophysiol. 2004;92:2428–93. doi:10.1152/jn.01144.2003.PubMedCrossRef

54.

Hamdy S, Aziz Q, Rothwell JC, Crone R, Hughes D, Tallis RC, et al. Explaining oropharyngeal dysphagia after unilateral hemispheric stroke. Lancet. 1997;350:686–92. doi:10.1016/S0140-6736(97)02068-0.PubMedCrossRef

55.

Hamdy S, Aziz Q, Rothwell JC, Power M, Singh KD, Nicholson DA, et al. Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex. Gastroenterology. 1998;115:1104–12. doi:10.1016/S0016-5085(98)70081-2.PubMedCrossRef

56.

Hamdy S, Rothwell JC, Aziz Q, Singh KD, Thompson DG. Long-term organization of human motor cortex driven by short-term sensory stimulation. Nat Neurosci. 1998;1:64–8. doi:10.1038/264.PubMedCrossRef

57.

Fraser C, Power M, Hamdy S, Rothwell J, Hobday D, Hollander I, et al. Driving plasticity in human adult motor cortex is associated with improved motor function after brain injury. Neuron. 2002;34:831–40. doi:10.1016/S0896-6273(02)00705-5.PubMedCrossRef

58.

Mese H, Matsuo R. Salivary secretion, taste and hyposalivation. J Oral Rehabil. 2007;34:711–23. doi:10.1111/j.1365-2842.2007.01794.x.PubMedCrossRef

59.

Ship JA, Pillemer SR, Baum BJ. Xerostomia and the geriatric patient. J Am Geriatr Soc. 2002;50:535–43. doi:10.1046/j.1532-5415.2002.50123.x.PubMedCrossRef

60.

Sreebny LM. Saliva in health and disease: An appraisal and update. Int Dent J. 2000;50:140–61.PubMed

61.

Sreebny LM. Recognition and treatment of salivary induced conditions. Int J Dent Res. 1989;39:197–294.

62.

Dawes C. Physiological factors affecting salivary flow rate, oral sugar clearance, and the sensation of dry mouth in man. J Dent Res. 1987;66:648–53.PubMed

63.

Gemba H, Teranaka A, Takemura K. Influences of emotion upon parotid secretion in human. Neurosci Lett. 1996;211:159–62. doi:10.1016/0304-3940(96)12741-5.PubMedCrossRef

64.

Dawes C. Circadian rhythms in human salivary flow rate and composition. J Physiol. 1972;220:529–45.PubMed

65.

Dawes C, Ong BY. Circadian rhythms in the flow rate and proportional contribution of parotid to whole saliva volume in man. Arch Oral Biol. 1973;18:1145–53. doi:10.1016/0003-9969(73)90088-5.PubMedCrossRef

66.

Dawes C. Rhythms in salivary flow rate and composition. Int J Chronobiol. 1974;2:253–79.PubMed

67.

Ferguson DB, Fort A, Elliot AL, Potts AJ. Circadian rhythms in human parotid saliva flow rate and composition. Arch Oral Biol. 1973;18:1155–73. doi:10.1016/0003-9969(73)90089-7.PubMedCrossRef

68.

Schneyer LH, Pigman W, Hanahan L, Gilmore RW. Rate of flow of human parotid, sublingual, and submaxillary secretions during sleep. J Dent Res. 1956;35:109–14.PubMed

69.

Bourdiol P, Mioche L, Monier S. Effect of age on salivary flow obtained under feeding and non-feeding conditions. J Oral Rehabil. 2004;31:445–52. doi:10.1111/j.1365-2842.2004.01253.x.PubMedCrossRef

70.

Baum BJ. Salivary gland fluid secretion during aging. J Am Geriatr Soc. 1989;37:453–8.PubMed

71.

Jafari S, Prince R, Kim D, Paydarfar D. Sensory regulation of swallowing and airway protection: a role for the internal superior laryngeal nerve in humans. J Physiol. 2003;550:287–304. doi:10.1113/jphysiol.2003.039966.PubMedCrossRef

72.

Mansson I, Sandberg N. Effects of surface anesthesia on deglutition in man. Laryngoscope. 1974;84:427–37. doi:10.1288/00005537-197403000-00006.PubMedCrossRef

73.

Kitagawa JI, Shingai T, Takahashi Y, Yamada Y. Pharyngeal branch of the glossopharyngeal nerve plays a major role in reflex swallowing from the pharynx. Am J Physiol. 2002;282:R1342–7.

74.

Sinclair WJ. Initiation of reflex swallowing from the naso-and oro-pharynx. Am J Physiol. 1970;218:956–60.PubMed

75.

Sinclair WJ. Role of pharyngeal plexus in initiation of swallowing. Am J Physiol. 1971;221:1260–3.PubMed

76.

Yoshida Y, Tanaka Y, Hirano M, Nakashima T. Sensory innervation of the pharynx and larynx. Am J Med. 2000;108:51S–61S. doi:10.1016/S0002-9343(99)00342-3.PubMedCrossRef

77.

Hamdy S, Jilani S, Price V, Parker C, Hall N, Power M. Modulation of human swallowing behaviour by thermal and chemical stimulation in health and after brain injury. Neurogastroenterol Motil. 2003;15:69–77. doi:10.1046/j.1365-2982.2003.00390.x.PubMedCrossRef

78.

Kaatzke-McDonald MN, Post E, Davis PJ. The effects of cold, touch, and chemical stimulation of the anterior faucial pillar on human swallowing. Dysphagia. 1996;11:198–206. doi:10.1007/BF00366386.PubMedCrossRef

79.

Sciortino K, Liss JM, Case JL, Gerritsen KGM, Katz RC. Effects of mechanical, cold, gustatory, and combined stimulation to the human anterior faucial pillars. Dysphagia. 2003;18:16–26. doi:10.1007/s00455-002-0076-1.PubMedCrossRef

80.

Logemann JA. Preswallow sensory input: Its potential importance to dysphagic patients and normal individuals. Dysphagia. 1996;11:9–10. doi:10.1007/BF00385792.PubMedCrossRef

81.

Jaradeh S. Neurophysiology of swallowing in the aged. Dysphagia. 1994;9:218–20. doi:10.1007/BF00301913.PubMedCrossRef

82.

Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51:S225–39. doi:10.1044/1092-4388(2008/018).

83.

Robbins J, Butler SG, Daniels SK, Diez Gross R, Langmore S, Lazarus CL, et al. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J Speech Lang Hear Res. 2008;51:S276–300. doi:10.1044/1092-4388(2008/021).PubMedCrossRef

84.

Martin RE. Neuroplasticity and swallowing. Dysphagia . doi: 10.1007/s00455-008-9193-9(2008).

Title: Effects of Oropharyngeal Air-Pulse Stimulation on Swallowing in Healthy Older Adults
Authors: Julie A. Theurer
Kathy A. Czachorowski
Lyndsay P. Martin
Ruth E. Martin
Publication date: 01-09-2009
Publisher: Springer-Verlag
Published in: Dysphagia / Issue 3/2009
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI: https://doi.org/10.1007/s00455-009-9207-2

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Effects of Oropharyngeal Air-Pulse Stimulation on Swallowing in Healthy Older Adults

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