, Volume 27, Issue 2, pp 162–177 | Cite as

Temporal Variability in the Deglutition Literature

  • Sonja M. MolfenterEmail author
  • Catriona M. Steele
Review Article


A literature review was conducted on temporal measures of swallowing in healthy individuals with the purpose of determining the degree of variability present in such measures within the literature. A total of 46 studies that met inclusion criteria were reviewed. The definitions and descriptive statistics for all reported temporal parameters were compiled for meta-analysis. In total, 119 different temporal parameters were found in the literature. The three most-frequently occurring durational measures were upper esophageal sphincter opening, laryngeal closure, and hyoid movement. The three most-frequently occurring interval measures were stage transition duration, pharyngeal transit time, and duration from laryngeal closure-to-UES opening. Subtle variations in operational definitions across studies were noted, making the comparison of data challenging. Analysis of forest plots compiling descriptive statistical data (means and 95% confidence intervals) across studies revealed differing degrees of variability across durations and intervals. Two parameters (UES opening duration and the laryngeal closure-to-UES opening interval) demonstrated the least variability, reflected by small ranges for mean values and tight confidence intervals. Trends emerged for factors of bolus size and participant age for some variables. Other potential sources of variability are discussed.


Deglutition Deglutition disorders Temporal Timing Duration Variability 



The first author has received funding for her doctoral studies from the Natural Sciences and Engineering Research Council (Canada) Create CARE program and the Ontario Student Opportunity Trust Fund. The second author holds a New Investigator award from the Canadian Institutes of Health Research. The authors acknowledge the support of Toronto Rehabilitation Institute which receives funding under the Provincial Rehabilitation Research Program from the Ministry of Health and Long-term Care in Ontario. The views expressed do not necessarily reflect those of the ministry.

Conflict of interest

The authors have no conflicts of interest to disclose.


  1. 1.
    Rosenbek JC, Roecker EB, Wood JL, Robbins J. Thermal application reduces the duration of stage transition in dysphagia after stroke. Dysphagia. 1996;11:225–33.PubMedCrossRefGoogle Scholar
  2. 2.
    Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment—MBSimp: establishing a standard. Dysphagia. 2008;23:392–405.PubMedCrossRefGoogle Scholar
  3. 3.
    Perlman AL, Booth BM, Grayhack JP. Videofluoroscopic predictors of aspiration in patients with oropharyngeal dysphagia. Dysphagia. 1994;9:90–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Molfenter SM, Steele CM. Physiological variability in the deglutition literature: hyoid and laryngeal kinematics. Dysphagia. 2011;26:67–74.PubMedCrossRefGoogle Scholar
  5. 5.
    Lof GL, Robbins J. Test-retest variability in normal swallowing. Dysphagia. 1990;4:236–42.PubMedCrossRefGoogle Scholar
  6. 6.
    Norman GR, Streiner DL. Biostatistics: the bare essentials. Hamilton: B.C. Decker Inc.; 2008.Google Scholar
  7. 7.
    van Geert P, van Dijk M. Focus on variability: new tools to study intra-individual variability in developmental data. Infant Behav Dev. 2002;25:340–74.CrossRefGoogle Scholar
  8. 8.
    Mendell DA, Logemann JA. Temporal sequence of swallow events during the oropharyngeal swallow. J Speech Lang Hear Res. 2007;50:1256–71.PubMedCrossRefGoogle Scholar
  9. 9.
    Kendall KA, Leonard RJ, McKenzie SW. Sequence variability during hypopharyngeal bolus transit. Dysphagia. 2003;18:85–91.PubMedCrossRefGoogle Scholar
  10. 10.
    Stephen JR, Taves DH, Smith RC, Martin RE. Bolus location at the initiation of the pharyngeal stage of swallowing in healthy older adults. Dysphagia. 2005;20:266–72.PubMedCrossRefGoogle Scholar
  11. 11.
    Martin-Harris B, Brodsky MB, Michel Y, Lee FS, Walters B. Delayed initiation of the pharyngeal swallow: normal variability in adult swallows. J Speech Lang Hear Res. 2007;50:585–94.PubMedCrossRefGoogle Scholar
  12. 12.
    Leonard R, McKenzie S. Hyoid-bolus transit latencies in normal swallow. Dysphagia. 2006;21:183–90.PubMedCrossRefGoogle Scholar
  13. 13.
    Kendall KA, McKenzie S, Leonard RJ, Gonçalves MI, Walker A. Timing of events in normal swallowing: a videofluoroscopic study. Dysphagia. 2000;15:74–83.PubMedGoogle Scholar
  14. 14.
    Kendall KA, Leonard RJ. Bolus transit and airway protection coordination in older dysphagic patients. Laryngoscope. 2001;111:2017–21.PubMedCrossRefGoogle Scholar
  15. 15.
    Kendall KA, Leonard RJ, McKenzie SW. Accommodation to changes in bolus viscosity in normal deglutition: a videofluoroscopic study. Ann Otol Rhinol Laryngol. 2001;110:1059–65.PubMedGoogle Scholar
  16. 16.
    Kendall KA, Leonard RJ, McKenzie S. Common medical conditions in the elderly: impact on pharyngeal bolus transit. Dysphagia. 2004;19:71–7.PubMedGoogle Scholar
  17. 17.
    Kendall KA, Leonard RJ. Videofluoroscopic upper esophageal sphincter function in elderly dysphagic patients. Laryngoscope. 2002;112:332–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Kendall KA, Leonard RJ. Hyoid movement during swallowing in older patients with dysphagia. Arch Otolaryngol Head Neck Surg. 2001;10:1224–9.Google Scholar
  19. 19.
    Kendall KA, Leonard RJ. Pharyngeal constriction in elderly dysphagic patients compared with young and elderly nondysphagic controls. Dysphagia. 2001;16:272–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Kim Y, McCullough GH, Asp CW. Temporal measurements of pharyngeal swallowing in normal populations. Dysphagia. 2005;20:290–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Mendell DA, Logemann JA. A retrospective analysis of the pharyngeal swallow in patients with a clinical diagnosis of GERD compared with normal controls: a pilot study. Dysphagia. 2002;17:220–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Logemann JA, Pauloski BR, Rademaker AW, Kahrilas PJ. Oropharyngeal swallow in younger and older women: videofluoroscopic analysis. J Speech Lang Hear Res. 2002;45:434–45.PubMedCrossRefGoogle Scholar
  23. 23.
    Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA, Kahrilas PJ, Smith CH. Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men. J Speech Lang Hear Res. 2000;43:1264–74.PubMedGoogle Scholar
  24. 24.
    Kang B, Oh B, Kim IS, Chung SG, Kim SJ, Han TR. Influence of aging on movement of the hyoid bone and epiglottis during normal swallowing: a motion analysis. Gerontology. 2010;56:474–82.PubMedCrossRefGoogle Scholar
  25. 25.
    Kim SJ, Han TR, Kwon TK. Kinematic analysis of hyolaryngeal complex movement in patients with dysphagia development after pneumonectomy. Thorac Cardiovasc Surg. 2010;58:108–12.PubMedCrossRefGoogle Scholar
  26. 26.
    Gay T, Rendell JK, Spiro J, Mosier K, Lurie AG. Coordination of oral cavity and laryngeal movements during swallowing. J Appl Physiol. 1994;77:357–65.PubMedGoogle Scholar
  27. 27.
    Ohmae Y, Logemann JA, Kaiser P, Hanson DG, Kahrilas PJ. Timing of glottic closure during normal swallow. Head Neck. 1995;17:394–402.PubMedCrossRefGoogle Scholar
  28. 28.
    Ohmae Y, Logemann JA, Kaiser P, Hanson DG, Kahrilas PJ. Effects of two breath-holding maneuvers on oropharyngeal swallow. Ann Otol Rhinol Laryngol. 1996;105:123–31.PubMedGoogle Scholar
  29. 29.
    Martin-Harris B, Brodsky MB, Price CC, Michel Y, Walters B. Temporal coordination of pharyngeal and laryngeal dynamics with breathing during swallowing: single liquid swallows. J Appl Physiol. 2003;94:1735–43.PubMedGoogle Scholar
  30. 30.
    Power ML, Hamdy S, Singh S, Tyrrell PJ, Turnbull I, Thompson DG. Deglutitive laryngeal closure in stroke patients. J Neurol Neurosurg Psychiatry. 2007;78:141–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Logemann JA, Kahrilas PJ, Cheng J, Pauloski BR, Gibbons PJ, Rademaker AW, Lin S. Closure mechanisms of laryngeal vestibule during swallow. Am J Physiol. 1992;262:G338–44.PubMedGoogle Scholar
  32. 32.
    Park T, Kim Y, Ko DH, McCullough G. Initiation and duration of laryngeal closure during the pharyngeal swallow in post-stroke patients. Dysphagia. 2010;25:177–82.PubMedCrossRefGoogle Scholar
  33. 33.
    Rofes L, Arreola V, Romea M, Palomera E, Almirall J, Cabré M, Serra-Prat M, Clavé P. Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol Motil. 2010;22:851–8 + e230.Google Scholar
  34. 34.
    Dantas RO, De Aguiar Cassiani R, Dos Santos CM, Gonzaga GC, Alves LMT, Mazin SC. Effect of gender on swallow event duration assessed by videofluoroscopy. Dysphagia. 2009;24:280–4.PubMedCrossRefGoogle Scholar
  35. 35.
    Daniels SK, Schroeder MF, DeGeorge PC, Corey DM, Foundas AL, Rosenbek JC. Defining and measuring dysphagia following stroke. Am J Speech Lang Pathol. 2009;18:74–81.PubMedCrossRefGoogle Scholar
  36. 36.
    Daniels SK, Schroeder MF, McClain M, Corey DM, Rosenbek JC, Foundas AL. Dysphagia in stroke: development of a standard method to examine swallowing recovery. J Rehabil Res Dev. 2006;21:347–55.CrossRefGoogle Scholar
  37. 37.
    Daniels SK, Schroeder MF, DeGeorge PC, Corey DM, Rosenbek JC. Effects of verbal cue on bolus flow during swallowing. Am J Speech Lang Pathol. 2007;16:140–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Komori M, Hyodo M, Gyo K. A swallowing evaluation with simultaneous videoendoscopy, ultrasonography and videofluorography in healthy controls. J Otorhinolaryngol Relat Spec. 2008;70:393–8.CrossRefGoogle Scholar
  39. 39.
    Taniguchi H, Tsukada T, Ootaki S, Yamada Y, Inoue M. Correspondence between food consistency and suprahyoid muscle activity, tongue pressure, and bolus transit times during the oropharyngeal phase of swallowing. J Appl Physiol. 2008;105:791–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Kim Y, McCullough GH. Stage transition duration in patients poststroke. Dysphagia. 2007;22:299–305.PubMedCrossRefGoogle Scholar
  41. 41.
    Mokhlesi B, Logemann JA, Rademaker AW, Stangl CA, Corbridge TC. Oropharyngeal deglutition in stable COPD. Chest. 2002;121:361–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Chi-Fishman G, Sonies BC. Motor strategy in rapid sequential swallowing: new insights. J Speech Lang Hear Res. 2000;43:1481–92.PubMedGoogle Scholar
  43. 43.
    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;108:982–9.PubMedGoogle Scholar
  44. 44.
    Kahrilas PJ, Logemann JA, Krugler C, Flanagan E. Volitional augmentation of upper esophageal sphincter opening during swallowing. Am J Physiol. 1991;260:G450–6.PubMedGoogle Scholar
  45. 45.
    Stachler RJ, Hamlet SL, Mathog RH, Jones L, Heilbrun LK, Manov LJ, O’Campo JM. Swallowing of bolus types by postsurgical head and neck cancer patients. Head Neck. 1994;16:413–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL. Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. J Speech Hear Res. 1994;37:1041–9.PubMedGoogle Scholar
  47. 47.
    Lazarus CL, Logemann JA, Rademaker AW, Kahrilas PJ, Pajak T, Lazar R, Halper A. Effects of bolus volume, viscosity, and repeated swallows in nonstroke subjects and stroke patients. Arch Phys Med Rehabil. 1993;74:1066–70.PubMedCrossRefGoogle Scholar
  48. 48.
    Palmer JB, Rudin NJ, Lara G, Crompton AW. Coordination of mastication and swallowing. Dysphagia. 1992;7:187–200.PubMedCrossRefGoogle Scholar
  49. 49.
    Cook IJ, Dodds WJ, Dantas RO, Massey B, Kern MK, Lang IM, Brausseur JG, Hogan WJ. Opening mechanisms of the human upper esophageal sphincter. Am J Physiol. 1989;257:G748–59.PubMedGoogle Scholar
  50. 50.
    Cook IJ, Dodds WJ, Dantas RO, Kern MK, Massey BT, Shaker R, Hogan WJ. Timing of videofluoroscopic, manometric events, and bolus transit during the oral and pharyngeal phases of swallowing. Dysphagia. 1989;4:8–15.PubMedCrossRefGoogle Scholar
  51. 51.
    Dantas RO, Dodds WJ, Massey BT, Kern MK. The effect of high- versus low-density barium preparations on the quantitative features of swallowing. AJR Am J Roentgenol. 1989;153:1191–5.PubMedGoogle Scholar
  52. 52.
    Dantas RO, Cook IJ, Dodds WJ, Kern MK, Lang IM, Brasseur JG. Biomechanics of cricopharyngeal bars. Gastroenterology. 1990;5:1269–74.Google Scholar
  53. 53.
    Dantas RO. Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing. Am J Physiol. 1990;258:G675.PubMedGoogle Scholar
  54. 54.
    Pauloski BR, Logemann JA, Fox JC, Colangelo LA. Biomechanical analysis of the pharyngeal swallow in postsurgical patients with anterior tongue and floor of mouth resection and distal flap reconstruction. J Speech Hear Res. 1995;38:110–23.PubMedGoogle Scholar
  55. 55.
    Zoratto D. Hyolaryngeal excursion as the physiological source of swallowing accelerometry signals. Physiol Meas. 2010;31:843–55.PubMedCrossRefGoogle Scholar
  56. 56.
    Ishida R, Palmer JB, Hiiemae KM. Hyoid motion during swallowing: factors affecting forward and upward displacement. Dysphagia. 2002;17:262–72.PubMedCrossRefGoogle Scholar
  57. 57.
    Stoeckli SJ, Huisman TAGM, Seifert B, Martin-Harris BJW. Interrater reliability of videofluoroscopic swallow evaluation. Dysphagia. 2003;18:53–7.PubMedCrossRefGoogle Scholar
  58. 58.
    McCullough GH, Wertz RT, Rosenbek JC, Mills RH, Webb WG, Ross KB. Inter- and intrajudge reliability for videofluoroscopic swallowing evaluation measures. Dysphagia. 2001;16:110–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Perlman AL, VanDaele DJ, Otterbacher MS. Quantitative assessment of hyoid bone displacement from video images during swallowing. J Speech Hear Res. 1995;38:579–85.PubMedGoogle Scholar
  60. 60.
    Steele CM, Bailey GL, Chau T, Molfenter SM, Oshalla M, Waito AA, Zoratto DCBH. The relationship between hyoid and laryngeal displacement and swallowing impairment. Clin Otolaryngol. 2001;36:30–6.CrossRefGoogle Scholar
  61. 61.
    Bonilha H, Blair J, Carnes BN, Humphries K, McGrattan K, Michele Y, Martin-Harris B. Effect of frame rate on judgement of swallowing function using the MBSImP. Dysphagia. 2011;26:441.Google Scholar
  62. 62.
    Max L, Onghena P. Some issues in the statistical analysis of completely randomized and repeated measures designs for speech, language, and hearing research. J Speech Lang Hear Res. 1999;42:261–70.PubMedGoogle Scholar
  63. 63.
    Johnson CJ. More on correct definition of the experimental unit: an extension of Max and Onghena (1999). J Speech Lang Hear Res. 2000;43:1290–3.PubMedGoogle Scholar
  64. 64.
    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:G675–81.PubMedGoogle Scholar
  65. 65.
    Langmore SE. Endoscopic evaluation and treatment of swallowing disorders. New York: Thieme; 2001.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation InstituteUniversity Health NetworkTorontoCanada
  2. 2.University of TorontoTorontoCanada
  3. 3.Bloorview Research InstituteHolland Bloorview Kids RehabTorontoCanada

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