ORIGINAL ARTICLE

Pharyngeal swallowing mechanics associated with upper esophageal sphincter pressure wave

Nelson H. May MD

Department of Otolaryngology—Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina

Kate W. Davidson MS, CCC-SLP

Speech Language Pathologist, Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, South Carolina

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William G. Pearson Jr, PhD,

William G. Pearson Jr, PhD

Department of Cellular Biology & Anatomy, Medical College of Georgia at Augusta University, Augusta, Georgia

Department of Otolaryngology, Medical College of Georgia at Augusta University, Augusta, Georgia

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Ashli K. O'Rourke MD,

Corresponding Author

Ashli K. O'Rourke MD

[email protected]

orcid.org/0000-0002-1293-501X

Department of Otolaryngology—Head and Neck Surgery, Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, South Carolina

Correspondence

Ashli K. O'Rourke, Department of Otolaryngology—Head and Neck Surgery, Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, 135 Rutledge Avenue MSC 550 Charleston, SC 29425.

Email: [email protected]

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Nelson H. May MD,

Nelson H. May MD

Department of Otolaryngology—Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina

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Kate W. Davidson MS, CCC-SLP,

Kate W. Davidson MS, CCC-SLP

Speech Language Pathologist, Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, South Carolina

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William G. Pearson Jr, PhD,

William G. Pearson Jr, PhD

Department of Cellular Biology & Anatomy, Medical College of Georgia at Augusta University, Augusta, Georgia

Department of Otolaryngology, Medical College of Georgia at Augusta University, Augusta, Georgia

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Ashli K. O'Rourke MD,

Corresponding Author

Ashli K. O'Rourke MD

[email protected]

orcid.org/0000-0002-1293-501X

Department of Otolaryngology—Head and Neck Surgery, Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, South Carolina

Correspondence

Email: [email protected]

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First published: 05 December 2019

https://doi.org/10.1002/hed.26029

Citations: 15

This work was presented at the International Dysphagia Research Society Annual Meeting, Baltimore, MD, March 15, 2018.

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Abstract

Background

Opening of the upper esophageal sphincter (UES) is a critical element of swallowing. Understanding the functional pharyngeal anatomy during UES opening would be clinically useful for dysphagia evaluation and treatment.

Methods

Simultaneous high-resolution pharyngeal manometry and videofluoroscopy (VFS) videos for 18 nondysphagic subjects were evaluated. UES pressure readings were segmented into six pressure phases, including a poorly understood pre-relaxation contraction. Anatomic landmarks were tracked in VFS imaging and evaluated morphometrically to determine the movement of key swallowing structures within each UES pressure phase.

Results

There were significant differences in pharyngeal mechanics by UES pressure stage (range of D-values = 1.7-2.2, P < .0001). The soft palate maximally elevates during the pre-relaxation contraction of the UES. Early during UES relaxation, the hyolaryngeal complex and pharyngeal structures maximally elevate and pharyngeal structures constrict around the bolus.

Conclusion

The mechanics underlying the UES pressure wave suggest generation of a sealed pharyngeal cavity, possibly integral to pharyngeal pressure generation and bolus propulsion.

CONFLICT OF INTEREST

N.H.M. and W.G.P. declare no potential conflict of interest. C.W.H. and A.K.O. are consultants for Medtronic, Inc.

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Volume42, Issue3

March 2020

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Pharyngeal swallowing mechanics associated with upper esophageal sphincter pressure wave

Abstract

Background

Methods

Results

Conclusion

CONFLICT OF INTEREST

REFERENCES

Citing Literature

References

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Pharyngeal swallowing mechanics associated with upper esophageal sphincter pressure wave

Abstract

Background

Methods

Results

Conclusion

CONFLICT OF INTEREST

REFERENCES

Citing Literature

References

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