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What is a normal pharynx? A videofluoroscopic study of anatomy in older adults



Structural and functional pharyngeal changes occur with age. How these affect swallowing in healthy older adults is not well defined. This study presents quantitative pharyngeal anatomic features in healthy adults using videofluoroscopic study of swallowing (VFSS). This will help our understanding of the normal changes in swallowing that occur with age and illustrate what may constitute normal variation compared with abnormal swallow function.


138 mixed gender adults with no history of dysphagia were recruited and underwent a standardized VFSS protocol. Parameters including age, BMI, and gender were correlated with the presence of a cricopharyngeal bar, spinal changes and pharyngeal wall thickness at rest.


46% of participants had notable spinal changes. 8% of participants demonstrated cricopharyngeal bars and 12% of subjects revealed osteophytes. Age positively correlated with the presence of a cricopharyngeal bar (rs = 0.281, p < 0.001) and presence of osteophytes (rs = 0.334, p < 0.001). The incidence of cricopharyngeal bars in adults over 70 years old was 16%.


A significant number of healthy adults with no swallowing complaints have variant pharyngeal anatomic findings such as cervical vertebral osteophytes and cricopharyngeal bars. This must be taken into account when assessing patients with dysphagia complaints to avoid misattribution of symptoms to these potentially asymptomatic variants. This ensures correct recommendations are made regarding management including diet modification, compensatory strategies, and surgical intervention.

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We thank the radiology department at North Shore Hospital, Waitemata District Health Board for their time and technical support with this project.


This study was funded by a University of Auckland Performance Based Research Funding Grant.

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Correspondence to Tary Yin.

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The authors declare that they have no conflict of interest.

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Ethics approval provided by the University of Auckland Human Participants Ethics Committee.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Auckland Human Participants Ethics Committee.

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Informed consent was obtained from all individual participants included in the study.

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Yin, T., Jardine, M., Miles, A. et al. What is a normal pharynx? A videofluoroscopic study of anatomy in older adults. Eur Arch Otorhinolaryngol 275, 2317–2323 (2018).

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  • Dysphagia
  • Cervical osteophyte
  • Cricopharyngeal bar
  • Videofluoroscopic swallowing study