Airway Protection: Evaluation with Videofluoroscopy
During videofluoroscopic swallowing studies performed in the lateral view, the arytenoid cartilages are seen to elevate and approximate the down-folding epiglottis, effectively closing the supraglottic larynx and protecting the airway. This mechanism may be incomplete or delayed in patients complaining of dysphagia and may lead to “penetration” of bolus material into the airway. This study evaluates the timing of supraglottic closure relative to the arrival of the bolus at the upper esophageal sphincter in 60 young control subjects and in 63 elderly control subjects without dysphagia. Event timing was measured in 0.01-s intervals from videofluoroscopic studies for two liquid bolus size categories. Results of the analysis revealed that, in most individuals, the arytenoid cartilages approximate the epiglottis prior to the arrival of the bolus at the upper esophageal sphincter. However, in both bolus size categories, there were individuals who achieved complete supraglottic closure after the bolus had arrived at the sphincter, but never greater than 0.1 s later. No delay in the timing of supraglottic closure relative to bolus arrival at the sphincter was found in the elderly subject group compared with the young subject group. The information from this study has allowed us to objectively determine if supraglottic closure timing is delayed in patients with dysphagia and to address any delay with strategies and exercises designed specifically to correct the delay. A case study is presented to illustrate the clinical significance of this study.
KeywordsDeglutition Aspiration Airway protection Swallowing Deglutition disorders.
Kahrilas, PJ, Lin, S, Rademaker, AW, Logemann, JA 1997Impaired deglutitive airway protection: a videofluoroscopic analysis of severity and mechanismGastroenterology11314571464PubMedGoogle Scholar
Morton, R, Minford, J, Ellis, R, Pinnington, L 2002Aspiration with dysphagia: the interaction between oropharyngeal and respiratory impairmentsDysphagia17192196CrossRefPubMedGoogle Scholar
Shaker, R, Dodds, WJ, Dantas, RO, Hogan, WJ, Arndorfer, RC 1990Coordination of deglutitive glottic closure with oropharyngeal swallowingGastroenterology9814781484PubMedGoogle Scholar
Maddock, DJ, Gilbert, RJ 1993Quantitative relationship between liquid bolus flow and laryngeal closure during deglutitionAm J Physiol265G704G711PubMedGoogle Scholar
Ohmae, Y, Logemann, JA, Kaiser, P, Hanson, DG, Kahrilas, PJ 1995Timing of glottic closure during normal swallowHead Neck17394402PubMedGoogle Scholar
Robbins, J, Hamilton, JW, Lof, GL, Kempster, GB 1992Oropharyngeal swallowing in normal adults of different agesGastroenterology103823829PubMedGoogle Scholar
Logemann, JA, Kahrilas, PJ, Cheng, J, Pauloski, BR, Gibbons, PJ, Rademaker, AW, Lin, S 1992Closure mechanisms of the laryngeal vestibule during swallowAm J Physiol262G338G344PubMedGoogle Scholar
Tracy, JF, Logemann, JA, Kahrilas, PJ, Jacob, P, Kobara, M, Krugler, C 1989Preliminary observations on the effects of age on oropharyngeal deglutitionDysphagia49094PubMedGoogle Scholar
Rademaker, AW, Pauloski, BR, Colangelo, LA, Logemann, JA 1998Age and volume effects on liquid swallowing function in normal womenJ Speech Language Hear Res41275284Google Scholar
Cook, IJ, Weltman, MD, Wallace, K, Shaw, DW, McKay, E, Smart, RC, Butler, SP 1994Influence of aging on oral-pharyngeal bolus transit and clearance during swallowing: scintigraphic studyAm J Physiol266G972977PubMedGoogle Scholar
Kendall, KA, Leonard, RJ 2001Bolus transit and airway protection coordination in older dysphagic patientsLaryngoscope11120172021CrossRefPubMedGoogle Scholar
Ren, J, Shaker, R, Zamir, Z, Dodds, WJ, Hogan, WJ, Hoffman, RG 1993Effect of age and bolus variables on the coordination of the glottis and upper esophageal sphincter during swallowingAm J Gastroenterol88665669PubMedGoogle Scholar
Zamir, Z, Ren, J, Hogan, WJ, Shaker, R 1996Coordination of deglutitive vocal cord closure and oral-pharyngeal swallowing events in the elderlyEur J Gastroenterol Hepatol8425429PubMedGoogle Scholar