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Dysphagia
Published in: Dysphagia 4/2020

01-08-2020 | Stroke | Original Article

Temporal and Sequential Analysis of the Pharyngeal Phase of Swallowing in Poststroke Patients

Authors: Mariana Saconato, Fabio Correa Leite, Henrique Manoel Lederman, Brasília Maria Chiari, Maria Inês Rebelo Gonçalves

Published in: Dysphagia | Issue 4/2020

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Abstract

The purpose of this study was to conduct a quantitative analysis of the temporal and sequential events of the pharyngeal phase of swallowing in 45 poststroke patients who presented or did not present with supraglottic penetration and/or laryngotracheal aspiration and to compare the groups with each other and to a group of 46 patients with normal swallowing. All individuals were assessed by videofluoroscopy and the temporal and sequential measures for the swallowing of 3 mL and 5 mL of thickened liquid, 3 mL of liquid, and 3 mL and 5 mL of pasty were obtained by analyzing the recorded exams on Virtual Dub software. The following events were measured: time of maximal displacement and sustaining of the hyoid and larynx, duration of velopharyngeal sphincter (VS) and supraglottic closure, total inversion time of the epiglottis, duration of pharyngeal constriction, and duration of upper esophageal sphincter (UES) opening. For the analysis of the temporal sequence, the initial time of larynx and hyoid elevation, VS closure, epiglottic inversion, supraglottic closure, pharyngeal constriction, and opening of the UES were obtained. For 5 mL of thickened liquid, the maximum hyoid elevation time was greater for patients with normal swallowing and the time the supraglottis remained closed was higher in the aspirators group. The time of pharyngeal constriction during swallowing of 3 mL of thickened liquid was lower in the aspirators group. During the swallowing of 3 mL of thin liquid, it was observed that in the aspirators group, the larynx took longer to reach its maximum elevation and the epiglottis took longer to complete its total inversion. The analysis of the temporal sequence showed that patients in the aspirators group presented greater disorganization with significant alteration of the time interval between the events.
Literature
1.
Perry L, Love CP. Screening for dysphagia and aspiration in acute stroke: a systematic review. Dysphagia. 2001;16(1):7–18.PubMed
2.
3.
Curtis DJ, Cruess DF, Dachman AH, Maso E. Timing in the normal pharyngeal swallow. Prospective selection and evaluation of 16 normal asymptomatic patients. Invest Radiol. 1984;19(6):523–9.PubMed
4.
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(3):209–17.PubMed
5.
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(5):474–82.PubMed
6.
Kendall KA, Leonard RJ. Hyoid movement during swallowing in older patients with dysphagia. Arch Otolaryngol Head Neck Surg. 2001;127(10):1224–9.PubMed
7.
Kendall KA, Leonard RJ. Pharyngeal constriction in elderly dysphagic patients compared with young and elderly nondysphagic controls. Dysphagia. 2001;16(4):272–8.PubMed
8.
Kendall KA, McKenzie S, Leonard RJ, Gonçalves MI, Walker A. Timing of events in normal swallowing: a videofluoroscopic study. Dysphagia. 2000;15(2):74–83.PubMed
9.
Kim Y, McCullough GH, Asp CW. Temporal measurements of pharyngeal swallowing in normal populations. Dysphagia. 2005;20(4):290–6.PubMed
10.
11.
Kim Y, McCullough GH. Stage transition duration in patients poststroke. Dysphagia. 2007;22(4):299–305.PubMed
12.
Lazarus CL, Logemann JA, Rademaker AW, Kahrilas PJ, Pajak T, Lazar R, Halper A. Effects of bolus volume, viscosity, and repeated swallows in nonstroke subjects and stroke patients. Arch Phys Med Rehabil. 1993;74(10):1066–70.PubMed
13.
Leonard R, Kendall KA, McKenzie S. Structural displacements affecting pharyngeal constriction in nondysphagic elderly and nonelderly adults. Dysphagia. 2004;19(2):133–41.PubMed
14.
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(5):1264–74.PubMed
15.
McConnel FM, Cerenko D, Jackson RT, Guffin TN Jr. Timing of major events of pharyngeal swallowing. Arch Otolaryngol Head Neck Surg. 1988;114(12):1413–8.PubMed
16.
Molfenter SM, Steele CM. Kinematic and temporal factors associated with penetration-aspiration in swallowing liquids. Dysphagia. 2014;29(2):269–76.PubMedPubMedCentral
17.
Molfenter SM, Steele CM. Variation in temporal measures of swallowing: sex and volume effects. Dysphagia. 2013;28(2):226–33.PubMed
18.
Nam HS, Oh BM, Han TR. Temporal characteristics of hyolaryngeal structural movements in normal swallowing. Laryngoscope. 2015;125(9):2129–33.PubMed
19.
Ohmae Y, Logemann JA, Kaiser P, Hanson DG, Kahrilas PJ. Timing of glottic closure during normal swallow. Head Neck. 1995;17(5):394–402.PubMed
20.
Rademaker AW, Pauloski BR, Logemann JA, Shanahan TK. Oropharyngeal swallow efficiency as a representative measure of swallowing function. J Speech Hear Res. 1994;37(2):314–25.PubMed
21.
Olthoff A, Zhang S, Schweizer R, Frahm J. On the physiology of normal swallowing as revealed by magnetic resonance imaging in real time. Gastroenterol Res Pract. 2014;2014:493174.PubMedPubMedCentral
22.
Hiss SG, Strauss M, Treole K, Stuart A, Boutilier S. Swallowing apnea as a function of airway closure. Dysphagia. 2003;18:293–300.PubMed
23.
Vandaele DJ, McCulloch TM, Palmer PM, Langmore SE. Timing of glottic closure during swallowing: a combined electromyographic and endoscopic analysis. Ann Otol Rhinol Laryngol. 2005;114(6):478–87.
24.
Power ML, Hamdy S, Singh S, Tyrrell PJ, Turnbull I, Thompson DG. Deglutitive laryngeal closure in stroke patients. J Neurol Neurosurg Psychiatry. 2007;78(2):141–6.PubMed
25.
Choi KH, Ryu JS, Kim MY, Kang JY, Yoo SD. Kinematic analysis of dysphagia: significant parameters of aspiration related to bolus viscosity. Dysphagia. 2011;26(4):392–8.PubMed
26.
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(3):177–82.PubMed
27.
Power ML, Hamdy S, Goulermas JY, Tyrrell PJ, Turnbull I, Thompson DG. Predicting aspiration after hemispheric stroke from timing measures of oropharyngeal bolus flow and laryngeal closure. Dysphagia. 2009;24(3):257–64.PubMed
28.
Seo HG, Oh BM, Han TR. Longitudinal changes of the swallowing process in subacute stroke patients with aspiration. Dysphagia. 2011;26(1):41–8.PubMed
29.
Gay T, Rendell JK, Spiro J. Oral and laryngeal muscle coordination during swallowing. Laryngoscope. 1994;104(3 Pt 1):341–9.PubMed
30.
Shaker R, Dodds WJ, Dantas RO, Hogan WJ, Arndorfer RC. Coordination of deglutitive glottic closure with oropharyngeal swallowing. Gastroenterology. 1990;98(6):1478–84.PubMed
31.
Zamir Z, Ren J, Hogan WJ, Shaker R. Coordination of deglutitive vocal cord closure and oral-pharyngeal swallowing events in the elderly. Eur J Gastroenterol Hepatol. 1996;8(5):425–9.PubMed
32.
Kendall KA, Leonard RJ, McKenzie SW. Sequence variability during hypopharyngeal bolus transit. Dysphagia. 2003;18(2):85–91.PubMed
33.
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. 2003;94(5):1735–43.PubMed
34.
Cook IJ, Dodds WJ, Dantas RO, Massey B, Kern MK, Lang IM, Brasseur JG, Hogan WJ. Opening mechanisms of the human upper esophageal sphincter. Am J Physiol. 1989;257:G748–G759759.PubMed
35.
Jacob P, Kahrilas PJ, Logemann JA, Shah V, Ha T. Upper esophageal sphincteropening and modulation during swallowing. Gastroenterology. 1989;97(6):1469–78.PubMed
36.
Ren J, Shaker R, Zamir Z, Dodds WJ, Hogan WJ, Hoffmann RG. Effect of age and bolus variables on the coordination of the glottis and upper esophageal sphincter during swallowing. Am J Gastroenterol. 1993;88(5):665–9.PubMed
37.
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(2):90–4.PubMed
38.
Mendell DA, Logemann JA. Temporal sequence of swallow events during the oropharyngeal swallow. J Speech Lang Hear Res. 2007;50(5):1256–71.PubMed
39.
Logemann JA, Pauloski BR, Rademaker AW, Kahrilas PJ. Oropharyngeal swallow in younger and older women: videofluoroscopic analysis. J Speech Lang Hear Res. 2002;45(3):434–45.PubMed
40.
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
41.
Herzberg EG, Lazarus CL, Steele CM, Molfenter SM. Swallow event sequencing: comparing healthy older and younger adults. Dysphagia. 2018;33:759–67.PubMedPubMedCentral
42.
Butler SG, Stuart A, Castell D, Russell GB, Koch K, Kemp S. Effects of age, gender, bolus condition, viscosity, and volume on pharyngeal and upper esophageal sphincter pressure and temporal measurements during swallowing. J Speech Lang Hear Res. 2009;52(1):240–53.PubMed
43.
Selley WG, Flack FC, Ellis RE, Brooks WA. Respiratory patterns associated with swallowing: part 2. Neurologically impaired dysphagic patients Age Ageing. 1989;18(3):173–6.PubMed
44.
Nilsson H, Ekberg O, Bülow M, Hindfelt B. Assessment of respiration during video fluoroscopy of dysphagic patients. Acad Radiol. 1997;4(7):503–7.PubMed
45.
Leslie P, Drinnan MJ, Ford GA, Wilson JA. Swallow respiration patterns in dysphagic patients following acute stroke. Dysphagia. 2002;17(3):202–7.PubMed
46.
Yotsuya H, Saito Y, Ide Y. Studies on temporal correlations of the movements of the pharyngeal organs during deglutition by X-ray TV cinematography. Bull Tokyo Dent Coll. 1981;22(3):171–81.PubMed
47.
Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL. Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. J Speech Lang Hearing Res. 1994;37(5):1041–9.
48.
Rofes L, Arreola V, Romea M, Palomera E, Almirall J, Cabré M, Serra-Prat M, Clavé P. Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol Motil. 2010;22:851–8.PubMed
49.
Clavé P, de Kraa M, Arreola V, Girvent M, Farré R, Palomera E, Serra-Prat M. The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment Pharmacol Ther. 2006;24(9):1385–94.PubMed
50.
Shaker R, Kern M, Bardan E, Taylor A, Stewart ET, Hoffmann RG, et al. Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise. Am J Physiol. 1997;272:G1518–G15221522.PubMed
51.
Fujiu M, Logemann J. Effect of a tongue-holding maneuver on posterior pharyngeal wall movement during deglutition. Am J Speech Lang Pathol. 1996;5:23–30.
52.
Bulow M, Olsson R, Ekberg O. Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. Dysphagia. 2001;16(3):190–5.PubMed
Metadata
Title
Temporal and Sequential Analysis of the Pharyngeal Phase of Swallowing in Poststroke Patients
Authors
Mariana Saconato
Fabio Correa Leite
Henrique Manoel Lederman
Brasília Maria Chiari
Maria Inês Rebelo Gonçalves
Publication date
01-08-2020
Publisher
Springer US
Published in
Dysphagia / Issue 4/2020
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI
https://doi.org/10.1007/s00455-019-10069-y

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