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Thin Liquid Bolus Volume Alters Pharyngeal Swallowing: Kinematic Analysis Using 3D Dynamic CT

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Abstract

The previous studies reported that different volumes of thick liquid had an impact on spatiotemporal characteristics and pharyngeal response of swallowing. However, the bolus flow and swallowing motion pattern were different between thick and thin liquids. The effects of thin bolus volume on pharyngeal swallowing, especially true vocal cord (TVC) closure is still unclear. This study assessed the temporal characteristics when swallowing different volumes of thin liquid to determine the mechanical adaptation using 320-row area detector computed tomography (320-ADCT) and investigated a change of swallowing physiology including laryngeal closure, particularly TVC closure. Fourteen healthy women (28–45 years) underwent 320-ADCT while swallowing of 3, 10, and 20 ml of thin liquid barium in 45° semi-reclining position. Kinematic analysis was performed for each swallow including temporal characteristic, structural movements while swallowing, and maximal cross-sectional area of the upper esophageal sphincter (UES) opening. Bolus head reached to pharynx and esophagus earlier in larger volume significantly, indicating faster bolus transport as volume increased. There were significant effects on swallowing mechanism revealing earlier TVC closure and UES opening with increasing volume. Maximum cross-sectional area of the UES opening was increased to accommodate a larger bolus. Differences in mechanical adaptation through bolus transit and motion of swallowing structures were detected across increasing volumes. These volume-dependent adaptations potentially reduce the risk of aspiration. Understanding the swallowing physiological changes as volume increased is helpful for diagnosis and treatment of dysphagia patients as well as outcomes of swallowing rehabilitation in clinical practice.

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Acknowledgements

The authors sincerely thank the radiological technologists at Fujita Health University Hospital for their assistance and suggestions with CT studies.

Funding

This study was partially supported by Japan Society for the Promotion of Science (JSPS) KAKENHI, Grant/Award Number 19K22310. Sponsor’s Role: None.

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Authors and Affiliations

  1. Department of Rehabilitation Medicine, Samitivej Srinakarin Hospital, Bangkok, Thailand

    Kannit Pongpipatpaiboon

  2. Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Kannit Pongpipatpaiboon, Yoko Inamoto, Hitoshi Kagaya, Seiko Shibata, Masahiko Mukaino & Eiichi Saitoh

  3. Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan

    Yoko Inamoto, Keiko Aihara & Eiichi Saitoh

  4. Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA

    Marlis Gonzalez-Fernandez

Authors
  1. Kannit Pongpipatpaiboon
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  2. Yoko Inamoto
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  3. Keiko Aihara
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  4. Hitoshi Kagaya
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  5. Seiko Shibata
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  6. Masahiko Mukaino
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  7. Eiichi Saitoh
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  8. Marlis Gonzalez-Fernandez
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Contributions

All authors contributed to the study conception and design. Study concept and design: YI, KP, ES, MGF; Data collection: YI, KP, KA; Statistical analysis: HK, MM; Data interpretation: YI, KP, ES, SS; Manuscript preparation: KP, YI, ES, MGF.

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Correspondence to Yoko Inamoto.

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Pongpipatpaiboon, K., Inamoto, Y., Aihara, K. et al. Thin Liquid Bolus Volume Alters Pharyngeal Swallowing: Kinematic Analysis Using 3D Dynamic CT. Dysphagia 37, 1423–1430 (2022). https://doi.org/10.1007/s00455-021-10397-y

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  • DOI: https://doi.org/10.1007/s00455-021-10397-y

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