Jerilyn A. Logemann

Upper esophageal sphincter function during deglutition.

Upper esophageal sphincter function was investigated during swallows of graded volumes in 8 normal volunteers. Concurrent recordings of video-fluoroscopic and manometric studies were obtained and correlated with each other by means of a videotimer. Maximal upper esophageal sphincter (UES) pressure was typically located 1.5 cm distal to the air-tissue interface between the hypopharynx and the proximal margin of the sphincter. The region in which UES pressure was greater than or equal to 50% maximal averaged 1.0 cm in length. Thus, the physiologic high-pressure zone of the UES corresponds in size and location to that of the cricopharyngeus muscle. Fluoroscopic analysis of sphincter movement indicated that the sphincter high-pressure zone moved 2.0-2.5 cm orally during swallowing and that the magnitude of the orad movement was directly related to the volume of barium swallowed. The maximal anterior-posterior diameter of sphincter opening during a swallow ranged from 0.9 to 1.5 cm and was also directly related to the volume swallowed. The intervals of UES opening and relaxation increased significantly with increasing bolus volume; the duration of UES relaxation ranged from a mean of 0.37 s for dry swallows to 0.65 s for 20-ml swallows. Thus, the dynamics of UES function during deglutition are dependent upon the volume of the swallowed bolus. Larger bolus volumes are accommodated by both an increased diameter of sphincter opening and by prolongation of the interval of sphincter relaxation. Analysis of the timing of other reference points within the pharyngeal swallow sequence indicated that as the manometric interval of UES relaxation increased, the period of laryngeal elevation was prolonged, the UES relaxed earlier and contracted later, and the interval between the onset of laryngeal elevation and hypopharyngeal contraction increased.

Pharyngeal Clearance During Swallowing: A Combined Manometric and Videofluoroscopic Study

The deglutitive pharyngeal contraction was analyzed using simultaneous videofluoroscopic and manometric studies of eight volunteers. Anterior, posterior, and longitudinal movements of the pharyngeal surfaces, relative to the cervical vertebrae, were measured during swallows of 5 and 10 mL of liquid barium. Profound pharyngeal shortening during bolus transit through the pharynx eliminated access to the larynx and elevated the upper esophageal sphincter to within 1.5 cm of the retrolingual pharynx. Bolus head movement through the pharynx preceded the propagated pharyngeal contraction and registered manometrically as a slight intrabolus pressure before the major pressure complex. Contraction in the horizontal plane began after bolus head transit and culminated with stripping of the bolus tail through the pharynx. Prolonged upper sphincter opening with the larger-volume swallows resulted from a delayed onset rather than altered propagation of the horizontal pharyngeal contraction. It is concluded that the propagated pharyngeal contraction facilitates pharyngeal clearance but has a minimal role in the process of bolus propulsion during swallowing. The propagated contraction works in concert with profound pharyngeal shortening to minimize hypopharyngeal residue after a swallow.

Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT®): a pilot study

Objective: To define the effects of Lee Silverman Voice Treatment (LSVT® on swallowing and voice in eight patients with idiopathic Parkinsons disease. Methods: Each patient received a modified barium swallow (MBS) in addition to voice recording before and after 1 month of LSVT®. Swallowing motility disorders were defined and temporal measures of the swallow were completed from the MBS. Voice evaluation included measures of vocal intensity, fundamental frequency, and the patients perception of speech change. Results: before LSVT®, the most prevalent swallowing motility disorders were oral phase problems including reduced tongue control and strength. Reduced tongue base retraction resulting in residue in the vallecula was the most common disorder in the pharyngeal stage of the swallow. Oral transit time (OTT) and pharyngeal transit time (PTT) were prolonged. After LSVT®, there was an overall 51% reduction in the number of swallowing motility disorders. Some temporal measures of swallowing were also significantly reduced as was the approximate amount of oral residue after 3 ml and 5 ml liquid swallows. Voice changes after LSVT® included a significant increase in vocal intensity during sustained vowel phonation as well as during reading. Conclusions: LSVT® seemingly improved neuromuscular control of the entire upper aerodigestive tract, improving oral tongue and tongue base function during the oral and pharyngeal phases of swallowing as well as improving vocal intensity.

Deglutitive tongue action: Volume accommodation and bolus propulsion

BACKGROUND Swallow function is best analyzed in components because discrete component failure may be compensated for with devised maneuvers, postures, or biofeedback techniques. The present investigation examined normal deglutitive tongue function. METHODS Biplane videofluoroscopy synchronized with intraluminal manometry was performed in eight volunteers. Tongue surface motion was characterized as centripetal or centrifugal along seven equiangular rays emanating from the tongue center during 1-, 5-, 10-, and 20-mL swallows. RESULTS The tongue perimeter remained in contact with the alveolar ridge while the central groove exhibited centripetal and subsequent centrifugal motion that, in conjunction with the pharyngeal walls, created an oropharyngeal propulsive chamber and then expelled that chambers contents into the hypopharynx. Intrabolus propulsive pressure was generated when the initially expansive propulsive chamber volume contracted to the test bolus volume. Because pharyngeal chamber action cycle timing was relatively constant among bolus volumes, vigorous expulsion occurred with large volumes but relatively delayed, sluggish expulsion occurred with smaller volumes. CONCLUSIONS Deglutitive tongue functions include bolus containment, volume accommodation, and the major contributor to bolus propulsion.

Swallowing dysfunction--preventative and rehabilitation strategies in patients with head-and-neck cancers treated with surgery, radiotherapy, and chemotherapy: a critical review.

BHARAT B. MITTAL, M.D.,* BARBARA R. PAULOSKI, PH.D., DANIEL J. HARAF, M.D., HAROLD J. PELZER, M.D., ATHANASSIOS ARGIRIS, M.D., EVERETT E. VOKES, M.D., ALFRED RADEMAKER, PH.D., AND JERILYN A. LOGEMANN, PH.D. Departments of *Radiology, Section of Radiation Oncology, Communication Sciences and Disorders, Head and Neck Surgery, Medical Oncology, and Biostatistics Core Facility, Northwestern University Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Chicago, IL; Departments of Radiation and Cellular Oncology, and Medicine, Division of Hematology-Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL

Viscosity effects on EMG activity in normal swallow

This study investigated the effects of six consistencies on measures of swallow duration, muscle activity, and sound. Electromyographic (EMG) recordings of the submental and infrahyoid muscle complexes, and audio recordings of neck sounds were made while 5 normal subjects swallowed two foods in each of three consistency categories: liquid, thin paste, and thick paste. Total swallow duration, measured from EMG, increased significantly across consistency categories from liquids to thin pastes to thick pastes. Liquids and thin pastes were significantly different from thick pastes on all but one EMG measure. However, liquids and thin pastes failed to reach significance on any of the EMG measures. EMG activity in the submental muscles most often initiated the swallow whereas the infrahyoid muscle activity most frequently terminated the swallow. A sound spike occurred at relatively the same time in each swallow. Results are discussed in terms of systematic modulations of muscle activity during swallow.

Pretreatment swallowing function in patients with head and neck cancer

Few objective data characterizing the pretreatment swallow function of patients with head and neck cancer are available.

Swallow function and perception of dysphagia in patients with head and neck cancer

The relationship between subjective complaints of dysphagia and objective measures of swallow function in patients with cancers of the oral cavity, pharynx, or larynx, treated with radiotherapy ± chemotherapy has not been well documented in the literature.

Surgical Variables Affecting Speech in Treated Patients With Oral and Oropharyngeal Cancer

Postoperative speech function may be influenced by a number of treatment variables. The objective of this study was to examine the relationships among various treatment factors to determine the impact of these measures on speech function. Speech function was tested prospectively in 142 patients with surgically treated oral and oropharyngeal cancer 3 months after treatment. Each patients speech was recorded during a 6‐ to 7‐minute conversation and while performing a standard articulation test, producing speech outcome measures of percent correct consonant phonemes and percent conversational understandability. Correlational analyses were used to determine the relationships among the speech outcome measures and 14 treatment parameters. Speech function was mildly to moderately negatively correlated with most surgical resection variables, indicating that larger amounts of tissue resected were associated with worse speech function. Overall measures of conversational understandability and percent correct consonant phonemes were related to extent of oral tongue resection, floor of mouth resection, soft palate resection, and total volume of tissue resected. These relationships varied depending on the method of surgical closure. Method of surgical reconstruction had a profound impact on postoperative speech function 3 months after treatment and was an important factor in determining how oral tongue resection influenced articulation and intelligibility. The combination of closure type, percent oral tongue resected, and percent soft palate resected had the strongest relationship with overall speech function for patients with surgically treated oral and oropharyngeal cancer 3 months after treatment.

SURGICAL VARIABLES AFFECTING SWALLOWING IN PATIENTS TREATED FOR ORAL/OROPHARYNGEAL CANCER

Postoperative swallowing function may be influenced by a number of treatment variables; this study examines the relationship of various treatment factors to measures of swallow function.