Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Dysphagia
Published in: Dysphagia 3/2019

01-06-2019 | Review Article

“Hidden in Plain Sight”: A Descriptive Review of Laryngeal Vestibule Closure

Authors: Alicia Vose, Ianessa Humbert

Published in: Dysphagia | Issue 3/2019

Login to get access

Abstract

A major emphasis in the evaluation of swallowing is to identify physiological abnormalities in swallowing that contribute to or explain unsafe swallowing (i.e., ingested material enters the trachea; post-swallow residue in the pharynx). Impairments in laryngeal vestibule closure are widely recognized as one of the major causes of unsafe swallowing, as it is the primary mechanism and first line of defense for preventing material from penetrating the airway during swallowing. However, this complex mechanism is often overlooked and understudied in swallowing research and dysphagia management. The purpose of this review is to promote a better understanding of the mechanism of laryngeal vestibule closure. We discuss where gaps in research exist and propose future directions for incorporating laryngeal vestibule closure as a primary outcome measure in swallowing research. Additionally, we propose that an increased knowledge of the mechanism of laryngeal vestibule closure will increase diagnostic accuracy and optimize dysphagia management for patients with dysphagia.
Literature
1.
2.
Kahrilas PJ, Lin S, Chen J, Logemann JA. Oropharyngeal accommodation to swallow volume. Gastroenterology. 1996;111:297–306.CrossRefPubMed
3.
Matsuo K, Palmer JB. Coordination of mastication, swallowing and breathing. Jpn Dent Sci Rev. 2009;45:31–40.CrossRefPubMed
4.
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.CrossRefPubMed
5.
Logemann J, Kahrilas P, Cheng J. Closure mechanisms of Laryngeal vestibule during swallow. Am J Physiol. 1992;262:338–44.
6.
Cabib C, Ortega O, Kumru H, Palomeras E, Vilardell N, Alvarez-Berdugo D, Muriana D, Rofes L, Terre R, Mearin F, Clave P. Neurorehabilitation strategies for poststroke oropharyngeal dysphagia: from compensation to the recovery of swallowing function. Ann New York Acad Sci. 2016;1380:121–38.CrossRef
7.
Schmidt J, Holas M, Halvorson K, Reding M. Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke. Dysphagia. 1994;9:7–11.CrossRefPubMed
8.
Holas MA, DePippo KL, Reding MJ. Aspiration and relative risk of medical complications following stroke. Arch Neurol. 1994;51:1051–3.CrossRefPubMed
9.
Langmore SE, Terpenning MS, Schork A, Chen Y, Murray JT, Lopatin D, Loesche WJ. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia. 1998;13:69–81.CrossRefPubMed
10.
11.
Patel DA, Krishnaswami S, Steger E, Conover E, Vaezi MF, Ciucci MR, Francis DO. Economic and survival burden of dysphagia among inpatients in the United States. Dis Esophagus. 2018;31:1–7.PubMed
12.
Ekberg O. Closure of the laryngeal vestibule during deglutition. Acta Oto Laryngol. 1982;93:123–9.CrossRef
13.
Ardran GM, Kemp FH. The protection of the laryngeal airway during swallowing. Br J Radiol. 1952;25:406–16.CrossRefPubMed
14.
Ardran GM, Kemp FH. Closure and opening of the larynx during swallowing. Br J Radiol. 1956;29:205–8.CrossRefPubMed
15.
Shaker R, Dodds WJ, Dantas RO. Coordination of deglutitive glottic closure with oropharyngeal swallow. Gastroenterology. 1990;98:1478–84.CrossRefPubMed
16.
Ohmae Y, Logemann JA, Kaiser P, Hanson DG, Kahrilas PJ. Timing of glottic closure during normal swallow. Head Neck. 1995;17:394–402.CrossRefPubMed
17.
Kawasaki A, Fukuda H, Shiotani A, Kanzaki J. Study of movements of individual structures of the larynx during swallowing. Auris Nasus Larynx. 2001;28:75–84.CrossRefPubMed
18.
Inamoto Y, Fujii N, Saitoh E, Baba M, Okada S, Katada K, Ozeki Y, Kanamori D, Palmer JB. Evaluation of swallowing using 320-detector-row multislice CT. Part II: kinematic analysis of laryngeal closure during normal swallowing. Dysphagia. 2011;26:209–17.CrossRefPubMed
19.
Shaker R, Dodds WJ, Dantas RO, Hogan WJ, Arndorfer RC. Coordination of deglutitive glottic closure with oropharyngeal swallowing. Gastroenterology. 1990;98:1478–84.CrossRefPubMed
20.
Ekberg O, Nylander G. Cineradiography of the pharyngeal stage of deglutition in 150 individuals without dysphagia. Br J Radiol. 1982;55:253–7.CrossRefPubMed
21.
Negus VE. The mechanism of the larynx. London: Wm. Heinemann (Medical Books), Ltd; 1949.
22.
23.
Humbert IA, Christopherson H, Lokhande A. Surface electrical stimulation perturbation context determines the presence of error reduction in swallowing hyolaryngeal kinematics. Am J Speech Lang Pathol. 2015;24:72–80.CrossRefPubMedPubMedCentral
24.
Fink BR. Folding mechanism of the human larynx. Acta Oto Laryngol. 1974;78:124–8.CrossRef
25.
Ekberg O, Sigurjonsson SV. Movement of the epiglottis during deglutition. A cineradiographic study. Gastrointest Radiol. 1982;7:101–7.CrossRefPubMed
26.
27.
Bielamowicz ALMaS. Textbook of laryngology. San Diego: Plural Publishing; 2006.
28.
Ekberg O, Sigurjonsson S. Movement of epiglottis during deglutition. Gastrointest Radiol. 1982;7:101–7.CrossRefPubMed
29.
Wirth R, Dziewas R, Beck AM, Clave P, Hamdy S, Heppner HJ, Langmore S, Leischker AH, Martino R, Pluschinski P, Rosler A, Shaker R, Warnecke T, Sieber CC, Volkert D. Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging. 2016;11:189–208.CrossRefPubMedPubMedCentral
30.
Ma MA, Kumar R, Macey PM, Yan-Go FL, Harper RM. Epiglottis cross-sectional area and oropharyngeal airway length in male and female obstructive sleep apnea patients. Nat Sci Sleep. 2016;8:297–304.CrossRefPubMedPubMedCentral
31.
Pearson WG Jr, Taylor BK, Blair J, Martin-Harris B. Computational analysis of swallowing mechanics underlying impaired epiglottic inversion. Laryngoscope. 2016;126:1854–8.CrossRefPubMed
32.
Palmer JB, Tanaka E, Ensrud E. Motions of the posterior pharyngeal wall in human swallowing: a quantitative videofluorographic study. Arch Phys Med Rehabil. 2000;81:1520–6.CrossRefPubMed
33.
Leonard R, Rees CJ, Belafsky P, Allen J. Fluoroscopic surrogate for pharyngeal strength: the pharyngeal constriction ratio (PCR). Dysphagia. 2011;26:13–7.CrossRefPubMed
34.
Fink BR, Martin RW, Rohrmann CA. Biomechanics of the human epiglottis. Acta Oto Laryngol. 1979;87:554–9.CrossRef
35.
Vandaele DJ, Perlman AL, Cassell MD. Intrinsic fibre architecture and attachments of the human epiglottis and their contributions to the mechanism of deglutition. J Anat. 1995;186(Pt 1):1–15.PubMedPubMedCentral
36.
Humbert IA, Poletto CJ, Saxon KG, Kearney PR, Crujido L, Wright-Harp W, Payne J, Jeffries N, Sonies BC, Ludlow CL. The effect of surface electrical stimulation on hyolaryngeal movement in normal individuals at rest and during swallowing. J Appl Physiol. 1985;101(1657–1663):2006.
37.
Anderson C, Macrae P, Taylor-Kamara I, Serel S, Vose A, Humbert IA. The perturbation paradigm modulates error-based learning in a highly automated task: outcomes in swallowing kinematics. J Appl Physiol. 1985;119(334–341):2015.
38.
Guedes R, Azola A, Macrae P, Sunday K, Mejia V, Vose A, Humbert IA. Examination of swallowing maneuver training and transfer of practiced behaviors to laryngeal vestibule kinematics in functional swallowing of healthy adults. Physiol Behav. 2017;174:155–61.CrossRefPubMedPubMedCentral
39.
Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–8.CrossRefPubMed
40.
Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment–MBSImp: establishing a standard. Dysphagia. 2008;23:392–405.CrossRefPubMedPubMedCentral
41.
Power ML, Hamdy S, Singh S, Tyrrell PJ, Turnbull I, Thompson DG. Deglutitive laryngeal closure in stroke patients. J Neurol Neurosurg Psychiatry. 2007;78:141–6.CrossRefPubMed
42.
Vose A, Kesneck S, Sunday K, Plowman EK, Humbert IA. A survey of clinician decision making when identifying swallowing impairments and determining treatment. J Speech Lang Hear Res (in press).
43.
Bonilha HS, Blair J, Carnes B, Huda W, Humphries K, McGrattan K, Michel Y, Martin-Harris B. Preliminary investigation of the effect of pulse rate on judgments of swallowing impairment and treatment recommendations. Dysphagia. 2013;28:528–38.CrossRefPubMed
44.
45.
Humbert IA, Sunday KL, Karagiorgos E, Vose AK, Gould F, Greene L, Tolar A, Rivet A. Swallowing kinematic differences across frozen, mixed, and ultrathin liquid boluses in healthy adults: age, sex, and normal variability. J Speech Lang Hear Res. 2018;61(7):1544–59.CrossRefPubMedPubMedCentral
46.
47.
Kendall KA, Leonard RJ, McKenzie SW. Accommodation to changes in bolus viscosity in normal deglutition: a videofluoroscopic study. Ann Otol Rhinol Laryngol. 2001;110:1059–65.CrossRefPubMed
48.
Kendall KA, McKenzie S, Leonard RJ, Goncalves MI, Walker A. Timing of events in normal swallowing: a videofluoroscopic study. Dysphagia. 2000;15:74–83.CrossRefPubMed
49.
Molfenter SM, Steele CM. Variation in temporal measures of swallowing: sex and volume effects. Dysphagia. 2013;28:226–33.CrossRefPubMed
50.
Nagy A, Molfenter SM, Peladeau-Pigeon M, Stokely S, Steele CM. The effect of bolus volume on hyoid kinematics in healthy swallowing. Biomed Res Int. 2014;2014:738971.PubMedPubMedCentral
51.
Cook IJ, Dodds WJ, Dantas RO, Kern MK, Massey BT, Shaker R, Hogan WJ. Timing of videofluoroscopic, manometric events, and bolus transit during the oral and pharyngeal phases of swallowing. Dysphagia. 1989;4:8–15.CrossRefPubMed
52.
Kendall KA, Leonard RJ, McKenzie SW. Sequence variability during hypopharyngeal bolus transit. Dysphagia. 2003;18:85–91.CrossRefPubMed
53.
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.CrossRefPubMed
54.
Logemann JA, Pauloski BR, Rademaker AW, Kahrilas PJ. Oropharyngeal swallow in younger and older women: videofluoroscopic analysis. J Speech Lang Hear Res. 2002;45:434–45.CrossRefPubMed
55.
Rosenbek JC, Roecker EB, Wood JL, Robbins J. Thermal application reduces the duration of stage transition in dysphagia after stroke. Dysphagia. 1996;11:225–33.CrossRefPubMed
56.
Kim Y, McCullough GH, Asp CW. Temporal measurements of pharyngeal swallowing in normal populations. Dysphagia. 2005;20:290–6.CrossRefPubMed
57.
Kang BS, Oh BM, Kim IS, Chung SG, Kim SJ, Han TR. Influence of aging on movement of the hyoid bone and epiglottis during normal swallowing: a motion analysis. Gerontology. 2010;56:474–82.CrossRefPubMed
58.
Kim SJ, Han TR, Kwon TK. Kinematic analysis of hyolaryngeal complex movement in patients with dysphagia development after pneumonectomy. Thorac Cardiovasc Surg. 2010;58:108–12.CrossRefPubMed
59.
Martin-Harris B, Brodsky MB, Price CC, Michel Y, Walters B. Temporal coordination of pharyngeal and laryngeal dynamics with breathing during swallowing: single liquid swallows. J Appl Physiol. 1985;94(1735–1743):2003.
60.
Rofes L, Arreola V, Romea M, Palomera E, Almirall J, Cabre M, Serra-Prat M, Clave P. Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol Motil. 2010;22:851–8.CrossRefPubMed
61.
Daniels SK, Corey DM, Hadskey LD, Legendre C, Priestly DH, Rosenbek JC, Foundas AL. Mechanism of sequential swallowing during straw drinking in healthy young and older adults. J Speech Lang Hear Res. 2004;47:33–45.CrossRefPubMed
62.
Dozier TS, Brodsky MB, Michel Y, Walters BC Jr, Martin-Harris B. Coordination of swallowing and respiration in normal sequential cup swallows. Laryngoscope. 2006;116:1489–93.CrossRefPubMed
63.
Hind JA, Nicosia MA, Roecker EB, Carnes ML, Robbins J. Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults. Arch Phys Med Rehabil. 2001;82:1661–5.CrossRefPubMed
64.
Macrae P, Anderson C, Taylor-Kamara I, Humbert I. The effects of feedback on volitional manipulation of airway protection during swallowing. J Motor Behav. 2014;46:133–9.CrossRef
65.
Young JL, Macrae P, Anderson C, Taylor-Kamara I, Humbert IA. The sequence of swallowing events during the chin-down posture. Am J Speech Lang Pathol. 2015;24:659–70.CrossRefPubMedPubMedCentral
66.
Azola AM, Greene LR, Taylor-Kamara I, Macrae P, Anderson C, Humbert IA. The relationship between submental surface electromyography and hyo-laryngeal kinematic measures of mendelsohn maneuver duration. J Speech Lang Hear Res. 2015;58:1627–36.CrossRefPubMedPubMedCentral
67.
Azola AM, Sunday KL, Humbert IA. Kinematic visual biofeedback improves accuracy of learning a swallowing maneuver and accuracy of clinician cues during training. Dysphagia. 2017;32:115–22.CrossRefPubMed
68.
Doty RW, Richmond WH, Storey AT. Effect of medullary lesions on coordination of deglutition. Exp Neurol. 1967;17:91–106.CrossRefPubMed
69.
Doty RW, Bosma JF. An electromyographic analysis of reflex deglutition. J Neurophysiol. 1956;19:44–60.CrossRefPubMed
70.
71.
Miller AJ. Characteristics of the swallowing reflex induced by peripheral nerve and brain stem stimulation. Exp Neurol. 1972;34:210–22.CrossRefPubMed
72.
Humbert IA, German RZ. New directions for understanding neural control in swallowing: the potential and promise of motor learning. Dysphagia. 2013;28:1–10.CrossRefPubMed
73.
Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999;30:744–8.CrossRefPubMed
74.
Robbins J, Levine RL, Maser A, Rosenbek JC, Kempster GB. Swallowing after unilateral stroke of the cerebral cortex. Arch Phys Med Rehabil. 1993;74:1295–300.CrossRefPubMed
75.
Park T, Kim Y, Ko DH, McCullough G. Initiation and duration of laryngeal closure during the pharyngeal swallow in post-stroke patients. Dysphagia. 2010;25:177–82.CrossRefPubMed
76.
Kahrilas PJ, Lin S, Rademaker AW, Logemann JA. Impaired deglutitive airway protection: a videofluoroscopic analysis of severity and mechanism. Gastroenterology. 1997;113:1457–64.CrossRefPubMed
77.
Clave P, de Kraa M, Arreola V, Girvent M, Farre R, Palomera E, Serra-Prat M. The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment Pharmacol Ther. 2006;24:1385–94.CrossRefPubMed
78.
Starmer HM, Quon H, Kumar R, Alcorn S, Murano E, Jones B, Humbert I. The effect of radiation dose on swallowing: evaluation of aspiration and kinematics. Dysphagia. 2015;30:430–7.CrossRefPubMed
79.
Ludlow CL, Humbert I, Saxon K, Poletto C, Sonies B, Crujido L. Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal Dysphagia. Dysphagia. 2007;22:1–10.CrossRefPubMedPubMedCentral
80.
Kendall KA. Evaluation of airway protection: quantitative timing measures versus penetration/aspiration score. Laryngoscope. 2017;127:2314–8.CrossRefPubMed
Metadata
Title
“Hidden in Plain Sight”: A Descriptive Review of Laryngeal Vestibule Closure
Authors
Alicia Vose
Ianessa Humbert
Publication date
01-06-2019
Publisher
Springer US
Published in
Dysphagia / Issue 3/2019
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI
https://doi.org/10.1007/s00455-018-9928-1

Other articles of this Issue 3/2019

Dysphagia 3/2019 Go to the issue

Original Article

Validation of the German Version of the Yale Pharyngeal Residue Severity Rating Scale

Original Article

Does the Hebrew Eating Assessment Tool-10 Correlate with Pharyngeal Residue, Penetration and Aspiration on Fiberoptic Endoscopic Examination of Swallowing?

Review

Radiation Exposure to Staff and Patient During Videofluoroscopic Swallowing Studies and Recommended Protection Strategies

Original Article

Assessing Hyolaryngeal Excursion: Comparing Quantitative Methods to Palpation at the Bedside and Visualization During Videofluoroscopy

Abstracts

Dysphagia Research Society 26th Anniversary Annual Meeting March 15–17, 2018 Renaissance Baltimore Harborplace Hotel, Baltimore, Maryland

Original Article

Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation on Swallowing Function and Quality of Life of Post-stroke Patients