Skip to main content
SpringerLink
Log in

The Effects of Aspiration Status, Liquid Type, and Bolus Volume on Pharyngeal Peak Pressure in Healthy Older Adults

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

The reasons for aspiration in healthy adults remain unknown. Given that the pharyngeal phase of swallowing is a key component of the safe swallow, it was hypothesized that healthy older adults who aspirate are likely to generate less pharyngeal peak pressures when swallowing. Accordingly, pharyngeal and upper esophageal sphincter pressures were examined as a function of aspiration status (i.e., nonaspirator vs. aspirator), sensor location (upper vs. lower pharynx), liquid type (i.e., water vs. milk), and volume (i.e., 5 vs. 10 ml) in healthy older adults. Manometric measurements were acquired with a 2.1-mm catheter during flexible endoscopic evaluation. Participants (N = 19, mean age = 79.2 years) contributed 28 swallows; during 8 swallows, simultaneous manometric measurements of upper and lower pharyngeal and upper esophageal pressures were obtained. Pharyngeal manometric peak pressure was significantly less for aspirators (mean = 82, SD = 31 mmHg) than for nonaspirators (mean = 112, SD = 20 mmHg), and upper pharyngeal pressures (mean = 85, SD = 32 mmHg) generated less pressure than lower pharyngeal pressures (mean = 116, SD = 38 mmHg). Manometric measurements vary with respect to aspiration status and sensor location. Lower pharyngeal pressures in healthy older adults may predispose them to aspiration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Witte U, Huckabee ML, Doeltgen SH, Gumbley F, Robb M. The effect of effortful swallow on pharyngeal manometric measurements during saliva and water swallowing in healthy participants. Arch Phys Med Rehabil. 2008;89(5):822–8.

    Article  PubMed  Google Scholar 

  2. Castell JA, Dalton CB, Castell DO. Pharyngeal and upper esophageal sphincter manometry in humans. Am J Physiol. 1990;258(2 Pt 1):G173–8.

    PubMed  CAS  Google Scholar 

  3. Perlman AL, Schultz JG, VanDaele DJ. Effects of age, gender, bolus volume, and bolus viscosity on oropharyngeal pressure during swallowing. J Appl Physiol. 1993;75(1):33–7.

    PubMed  CAS  Google Scholar 

  4. Dodds WJ, Hogan WJ, Lydon SB, Stewart ET, Stef JJ, Arndorfer RC. Quantitation of pharyngeal motor function in normal human subjects. J Appl Physiol. 1975;39(4):692–6.

    PubMed  CAS  Google Scholar 

  5. Cerenko D, McConnel FM, Jackson RT. Quantitative assessment of pharyngeal bolus driving forces. Otolaryngol Head Neck Surg. 1989;100(1):57–63.

    PubMed  CAS  Google Scholar 

  6. Dantas RO, Kern MK, Massey BT, Dodds WJ, Kahrilas PJ, Brasseur JG, Cook IJ, Lang IM. Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing. Am J Physiol. 1990;258(5 Pt 1):G675–81.

    PubMed  CAS  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. Gumbley F, Huckabee ML, Doeltgen SH, Witte U, Moran C. Effects of bolus volume on pharyngeal contact pressure during normal swallowing. Dysphagia. 2008;23(3):280–5.

    Article  PubMed  Google Scholar 

  9. Kahrilas PJ, Logemann JA, Lin S, Ergun GA. Pharyngeal clearance during swallowing: a combined manometric and videofluoroscopic study. Gastroenterology. 1992;103(1):128–36.

    PubMed  CAS  Google Scholar 

  10. Ghosh SK, Pandolfino JE, Zhang Q, Jarosz A, Kahrilas PJ. Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry. Am J Physiol Gastrointest Liver Physiol. 2006;291(3):G525–31.

    Article  PubMed  CAS  Google Scholar 

  11. 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(5 Pt 1):G748–59.

    PubMed  CAS  Google Scholar 

  12. Jacob P, Kahrilas PJ, Logemann JA, Shah V, Ha T. Upper esophageal sphincter opening and modulation during swallowing. Gastroenterology. 1989;97(6):1469–78.

    PubMed  CAS  Google Scholar 

  13. Kern M, Bardan E, Arndorfer R, Hofmann C, Ren J, Shaker R. Comparison of upper esophageal sphincter opening in healthy asymptomatic young and elderly volunteers. Ann Otol Rhinol Laryngol. 1999;108(10):982–9.

    PubMed  CAS  Google Scholar 

  14. Olsson R, Nilsson H, Ekberg O. Simultaneous videoradiography and pharyngeal solid state manometry (videomanometry) in 25 nondysphagic volunteers. Dysphagia. 1995;10(1):36–41.

    Article  PubMed  CAS  Google Scholar 

  15. Huckabee ML, Butler SG, Barclay M, Jit S. Submental surface electromyographic measurement and pharyngeal pressures during normal and effortful swallowing. Arch Phys Med Rehabil. 2005;86(11):2144–9.

    Article  PubMed  Google Scholar 

  16. Butler SG, Stuart A, Kemp S. Flexible endoscopic evaluation of swallowing in healthy young and older adults. Ann Otol Rhinol Laryngol. 2009;118(2):99–106.

    PubMed  Google Scholar 

  17. Butler SG, Stuart A, Markley L, Rees C. Penetration and aspiration in healthy older adults as assessed during endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol. 2009;118(3):190–8.

    PubMed  Google Scholar 

  18. Belafsky PC, Postma GN. Validity and reliability of the reflux symptom index (RSI). J Voice. 2002;16(2):274–7.

    Article  PubMed  Google Scholar 

  19. Salassa JR, DeVault KR, McConnel FM. Proposed catheter standards for pharyngeal manofluorography (videomanometry). Dysphagia. 1998;13:105–10.

    Article  PubMed  CAS  Google Scholar 

  20. Hiss SG, Huckabee ML. Timing of pharyngeal and upper esophageal sphincter pressures as a function of normal and effortful swallowing in young healthy adults. Dysphagia. 2005;20(2):149–56.

    Article  PubMed  Google Scholar 

  21. Castell JA, Castell DO. Recent developments in the manometric assessment of upper esophageal sphincter function and dysfunction. Dig Dis. 1997;15(Suppl 1):28–39.

    Article  PubMed  Google Scholar 

  22. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8.

    Article  PubMed  CAS  Google Scholar 

  23. Keppel G, Wickens TD. Design and analysis: a researcher’s handbook. 4th ed. Englewood Cliffs, NJ: Prentice Hall; 2004.

    Google Scholar 

  24. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1989.

    Google Scholar 

  25. Fries JF. Aging, natural death, and the compression of morbidity. N Engl J Med. 1980;303(3):130–5.

    Article  PubMed  CAS  Google Scholar 

  26. Rantanen T, Harris T, Leveille SG, Visser M, Foley D, Masaki K, Guralinik JM. Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. J Gerontol A Biol Sci Med Sci. 2000;55:M168–73.

    Article  PubMed  CAS  Google Scholar 

  27. Crow HC, Ship JA. Tongue strength and endurance in different aged individuals. J Gerontol A Biol Sci Med Sci. 1996;51(5):M247–50.

    Article  PubMed  CAS  Google Scholar 

  28. Nicosia MA, Hind JA, Roecker EB, Carnes M, Doyle J, Dengel GA, Robbins J. Age effects on the temporal evolution of isometric and swallowing pressure. J Gerontol A Biol Sci Med Sci. 2000;55(11):M634–40.

    Article  PubMed  CAS  Google Scholar 

  29. Stierwalt JA, Youmans SR. Tongue measures in individuals with normal and impaired swallowing. Am J Speech Lang Pathol. 2007;16(2):148–56.

    Article  PubMed  Google Scholar 

  30. Robbins J, Levine R, Wood J, Roecker EB, Luschei E. Age effects on lingual pressure generation as a risk factor for dysphagia. J Gerontol A Biol Sci Med Sci. 1995;50(5):M257–62.

    Article  PubMed  CAS  Google Scholar 

  31. Youmans SR, Stierwalt JA. Measures of tongue function related to normal swallowing. Dysphagia. 2006;21(2):102–11.

    Article  PubMed  Google Scholar 

  32. Youmans SR, Youmans GL, Stierwalt JA. Differences in tongue strength across age and gender: is there a diminished strength reserve? Dysphagia. 2009;24(1):57–65.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by a new investigators research grant from the American Speech Language Hearing Foundation and in part by the Wake Forest School of Medicine Claude D. Pepper Older Americans Independence Center (P30 AG21332). We thank Karen Potvin Klein, MA, ELS (Research Support Core, Wake Forest University Health Sciences) for her editorial contributions to the manuscript.

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    Susan G. Butler, Catherine Rees, Jeff Williamson & Stephen Kritchevsky

  2. Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, 27858, USA

    Andrew Stuart

  3. Department of Communication Sciences and Disorders, Appalachian State University, Boone, NC, 28608, USA

    Erika Wilhelm

Authors
  1. Susan G. Butler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew Stuart
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Erika Wilhelm
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Catherine Rees
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeff Williamson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephen Kritchevsky
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susan G. Butler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Butler, S.G., Stuart, A., Wilhelm, E. et al. The Effects of Aspiration Status, Liquid Type, and Bolus Volume on Pharyngeal Peak Pressure in Healthy Older Adults. Dysphagia 26, 225–231 (2011). https://doi.org/10.1007/s00455-010-9290-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-010-9290-4

Keywords

Search

Navigation