Carla Manfredi dos Santos

Gender effect on the clinical measurement of swallowing.

BACKGROUND Swallowing coordination is affected by cortical and subcortical inputs from the central nervous system. Our hypothesis is that the swallowing dynamics may be influenced by gender. AIM To evaluate the influence of gender on water swallowing dynamics. METHODS We studied 111 health subjects, 36 men, aged 24-77 years (mean: 46.3 +/- 16.1 years) and 75 women, aged 22-75 years (mean: 39.6 +/- 13.3 years). All volunteers swallowed in triplicate 50 mL of water at 4 degrees C while precisely timed, when we measured the time to swallow all the volume and counted the number of swallows. We calculated the inter-swallow interval: the time to complete the task, in seconds, divided by the number of swallows; swallowing velocity: volume drunk (mL) by the time taken (s); swallowing volume capacity: volume drunk (mL) divided by the number of swallows. RESULTS Women had a shorter inter-swallow interval, slower swallowing velocity and lower volume capacity than men. CONCLUSION Gender has an effect on water swallowing dynamics, with women having a lower swallowing velocity and a lower volume capacity in each swallow than men.

Clinical measurement of swallowing and proximal esophageal contractions in Chagas’ disease

BackgroundChagas’ disease causes esophageal motility impairment similar to that seen in idiopathic achalasia. Our hypothesis is that the disease could affect the results of swallowing evaluation and the esophageal response to swallows.MethodsWe studied, by the water-swallowing test, the swallowing dynamics of 40 patients with esophageal involvement by Chagas’ disease and 75 controls. During the clinical test, each subject ingested 50 ml of water while we precisely timed and counted the number of swallows. We calculated the interswallow interval, the swallowing flow rate, and the swallowing volume capacity. We also evaluated the proximal esophageal contractions of 32 patients with Chagas’ disease and 31 controls. After swallows in duplicate of 3 ml water, the pharyngeal contractions 1 cm above the upper esophageal sphincter and the proximal esophageal body contractions 5 cm from the pharyngeal recording point were recorded.ResultsIn the water-swallowing test, patients with Chagas’ disease took a longer time to drink all the volume, had a higher number of swallows, a longer interswallow interval, a lower swallowing flow rate, and took a smaller volume in each swallow than the control subjects. Patients with Chagas’ disease had a longer interval between onset of pharyngeal and onset of proximal esophageal contractions and had contractions of lower amplitude.ConclusionsWe conclude that patients with esophageal involvement by Chagas’ disease ingest water more slowly, with a smaller volume in each swallow, and have a later proximal esophageal response to swallows than normal subjects.

Effect of age on proximal esophageal response to swallowing

CONTEXT It has been demonstrated that the ageing process affects esophageal motility. OBJECTIVES To evaluate the effect of the age on the proximal esophageal response to wet swallows. METHOD We measured the proximal esophageal response to swallows of a 5 mL bolus of water in 69 healthy volunteers, 20 of them aged 18-30 years (group I), 27 aged 31-50 years (group II), and 22 aged 51-74 years (group III). We used the manometric method with continuous perfusion. The proximal esophageal contractions were recorded 5 cm from a pharyngeal recording site located 1 cm above the upper esophageal sphincter. The time between the onset of the pharyngeal and of the proximal esophageal recording (pharyngeal-esophageal time) and the amplitude, duration and area under the curve of the proximal esophageal contraction were measured. RESULTS The pharyngeal-esophageal time was shorter in group I subjects than in group II and III subjects (P<0.05). The duration of proximal esophageal contractions was longer in group I than in groups II and III (P<0.001). There was no differences between groups in the amplitude or area under the curve of contractions. There were no differences between groups II and III for any of the measurements. CONCLUSION We conclude that the age may affects the response of the proximal esophagus to wet swallows.

The relationship between the oral and pharyngeal phases of swallowing

OBJECTIVE: This study was designed to investigate a possible relationship between the duration of the oral and pharyngeal phases of swallowing. INTRODUCTION: The oral and pharyngeal phases of swallowing are independent from each other but may be related. METHODS: We used videofluoroscopy to evaluate 30 healthy volunteers between 29 and 77 years of age who swallowed 5- and 10-ml liquid and paste boluses in duplicate. The duration of the oral phase, pharyngeal transit, and pharyngeal clearance were measured. RESULTS: There were no differences in oral or pharyngeal transit times between the liquid and paste boluses or between the volumes of 5 and 10 ml (p>0.40). The pharyngeal clearance time for the paste bolus (0.48±0.27 s) was longer than for the liquid bolus (0.38±0.11 s, p = 0.03) with no difference between the volumes of 5 and 10 ml. There was no significant correlation between the oral transit time and the duration of pharyngeal transit for the liquid (5 ml, Spearmans coefficient ρ: −0.14; 10 ml, ρ: 0.18) or the paste (5 ml, ρ: 0.08; 10 ml, ρ: 0.10). The correlation between the oral transit time and the pharyngeal clearance time was not significant for the liquid bolus (5 ml, ρ: 0.31; 10 ml, ρ: 0.18), but it was significant for both the 5 ml (ρ: 0.71) and 10 ml (ρ: 0.64) paste boluses. DISCUSSION: The relationship between the oral and pharyngeal phases of swallowing can be affected by bolus consistency. CONCLUSION: There is a correlation between the duration of oral transit and the duration of pharyngeal clearance during the swallowing of paste boluses.

Possible interaction of gender and age on human swallowing behavior

CONTEXT The swallowing behavior is affected by age and possibly by gender. However, the interaction of the effects of age and gender on swallowing is not completely known. OBJECTIVES To evaluate the possibility of interaction of gender and age on human swallowing behavior. METHOD Swallowing was evaluated in 89 healthy subjects by the water swallowing test, 43 men and 46 women aged 20-40 years (younger, n = 38), 41-60 years (middle-aged, n = 31) and 61-80 years (older, n = 20). Each subject ingested in triplicate 50 mL of water while precisely timed and the number of swallows needed to ingest all the volume was counted. RESULTS The interval between swallows was shorter and the volume in each swallow was smaller in women compared to men. In older subjects the time to ingest the 50 mL of water was longer, the interval between swallows was longer, and swallowing flow and volume in each swallow were smaller than in younger and middle-aged subjects. The swallowing flow was lower in women compared to men in younger subjects. The volume of each swallow was smaller in women than in men in younger and middle-aged subjects. There was no difference in swallowing flow and volume between older men and older women. CONCLUSION Age and gender influence swallowing behavior, with the effect of gender being more evident in younger subjects and the effect of age being more evident in men.

Oral and pharyngeal bolus transit in patients with chronic obstructive pulmonary disease

Background Patients with respiratory diseases, such as chronic obstructive pulmonary disease (COPD), may have swallowing dysfunction. Objective The aim of this investigation was to evaluate the oral and pharyngeal phases of swallowing in patients with COPD. Methods We studied 16 patients with clinical manifestations and pulmonary function tests diagnosis of COPD (mean age: 68 years) and 15 nonsmoking healthy volunteers (mean age: 65 years) with normal pulmonary function tests. All subjects were submitted to clinical and videofluoroscopic evaluation of swallowing. Each subject performed in duplicate swallows of 5 mL and 10 mL of liquid bolus, paste bolus, and a solid bolus. Results In general, the duration of the events of the pharyngeal phase of swallowing was longer in COPD patients than controls. The difference was significant in the laryngeal vestibular closure, hyoid movement, and pharyngeal transit with swallows of both volumes of liquid bolus; in oral–pharyngeal transit with 5 mL paste bolus; and in pharyngeal and oral–pharyngeal transit with solid bolus. The difference between the duration of maximal laryngeal elevation and the duration of pharyngeal transit was higher in control subjects than in patients with COPD. Conclusion The results suggested that patients with COPD have a longer pharyngeal swallowing phase than normal subjects, which is associated with a decrease in the difference between the duration of maximal laryngeal elevation and the duration of pharyngeal transit.

Avaliação clínica da deglutição na doença de Chagas

OBJETIVO: Avaliar clinicamente a degluticao orofaringea de pacientes portadores da doenca de Chagas com disfagia e comparar os achados da anamnese entre os doentes chagasicos de acordo com o grau do megaesofago. METODOS: Utilizando protocolo de avaliacao, estudamos a degluticao de 21 pacientes com doenca de Chagas e comprometimento do esofago diagnosticado por sorologia e exame radiologico do esofago, e de 18 sujeitos sadios assintomaticos pareados por idade e genero. Nos dois grupos foi realizada anamnese contendo questoes relacionadas a queixa de disfagia. Apos este procedimento, foi realizada avaliacao clinica da degluticao, sem introducao de dieta via oral e com dieta via oral nas consistencias liquida e pastosa, abrangendo aspectos estruturais e funcionais. Os resultados foram analisados estatisticamente. Este e um estudo experimental e transversal. RESULTADOS: Maior proporcao de pacientes chagasicos apresentou degluticoes multiplas e elevacao laringea reduzida na degluticao das consistencias liquida e pastosa, em relacao aos sujeitos sadios. Os pacientes com aumento do diâmetro do esofago referiram mais frequentemente queixa de perda de peso quando comparados aos pacientes sem aumento do diâmetro do esofago. CONCLUSAO: Os pacientes chagasicos podem apresentar alteracoes na degluticao orofaringeana e pacientes com maior comprometimento do esofago apresentam maior perda de peso do que os pacientes com menor comprometimento.

Competência glótica na doença pulmonar obstrutiva crônica

PURPOSE: This study correlates the extent of maximum phonation time (MPT) with the volume of air exhaled in the first second pulmonary (FEV1) and compares the MPT emission of /s/, /z/ and s/z ratio in healthy subjects and those with chronic obstructive pulmonary disease (COPD). METHODS: We studied 14 normal volunteers (control group), mean age 65 years, and 16 patients with COPD, mean age 68 years. The diagnosis of COPD was done by clinical and pulmonary function evaluation. Participants underwent spirometry for analysis of the parameters FEV1, forced vital capacity (FVC) and Tiffeneau index (FEV1/FVC). The maximum phonation time, along with phonemes /s/ and /z/, s/z ratio correlation, and maximum phonation time in both normal and forced phonation were collected and recorded. RESULTS: In both groups, the maximum phonation time with normal phonation was lower than the maximum phonation time with forced phonation. The median of the maximum phonation time in the control group was higher than in the COPD group. There was no correlation between the maximum phonation time and FEV1, in normal volunteers and patients with COPD. CONCLUSION: Patients with COPD have decreased maximum phonation time, while the s/z ratio does not suggest changes in the level of the vocal folds, since the values found were within the normal range. There was no correlation of the TMF and the measure of FEV1.

Timing of Pharyngeal Swallow Events in Chagas’ Disease

Background Esophageal involvement by Chagas’ disease causes a significative decrease in the number of neurons of the esophageal myenteric plexus, causing an impairment of esophageal motility with the same alterations described in primary esophageal achalasia. There is also a longer duration of pharyngeal transit, which might be consequent of the involvement of the central control of swallowing by the disease, or an adaptation of the pharynx to the difficult bolus transit through the esophagus, which could contribute to the complaint of dysphagia. Methods We studied, by videofluoroscopy, the sequence and timings of pharyngeal bolus transit in 16 patients with esophageal involvement by Chagas’ disease and 12 healthy volunteers. Each subject swallowed in duplicate 5 mL and 10 mL of liquid and paste boluses. Results There was no difference between Chagas’ disease patients and normal volunteers in the sequence and timing of events associated with pharyngeal bolus flow, for liquid and paste boluses, and for 5 mL and 10 mL. Conclusion The timing and sequence of swallow pharyngeal events of patients with Chagas’ disease do not differ from that of control subjects, which suggested that the central control of swallowing is not impaired by the disease.

Variability of Oral and Pharyngeal Transit Between Two Consecutive Swallows in Chagas' Disease.

Background Chagas’ disease causes dysphagia, regurgitation and retention of food in the esophageal body. Patients have longer pharyngeal clearance, which might be consequent of the involvement of the central nervous system or an adaptation to the esophageal transit impairment. If there is central nervous system involvement by the disease, we expect a larger difference in the oral and pharyngeal phases of swallowing between two consecutive swallows than that seen in controls. Our objective was to evaluate the difference of oral and pharyngeal transit duration between two consecutive swallows in patients with Chagas’ disease compared with controls. Methods By videofluoroscopy, the duration of oral and pharyngeal transit, pharyngeal clearance, upper esophageal sphincter transit, hyoid movement and oropharyngeal transit was measured in 17 patients with Chagas’ disease and 15 asymptomatic volunteers. Each subject swallowed in duplicate and in sequence 5 mL and 10 mL of barium liquid and 5 mL and 10 mL of barium paste boluses. The differences were calculated between the two swallows of each volume and consistency in patients and controls. Results There were no differences between controls and patients in the values of the differences between the two consecutive swallows, except for the hyoid movement duration of the 5 mL liquid bolus, causing a higher difference in controls than in patients. Conclusion Oral and pharyngeal transit variation between two consecutive swallows is similar between patients with Chagas’ disease and controls, which suggests that the longer pharyngeal clearance duration previously described is not a consequence of impairment of the central nervous system control of swallowing.