Dysphagia incidence can be up to 90% of patients after CVA disease and most of the patients demonstrate speech problems as well as dysphagia. The term of swallowing includes the entire process of deglutition from the placement of food in the mouth until the food enters to the esophagus through the oral and pharyngeal cavities. Swallowing functions share common anatomic structures and characteristics of physiology with speech in many aspects. Therefore, speech-language pathologists can help people with swallowing disorders. Herein the approaches and rationales for improving speech and swallowing functions in patients with stroke need to be discussed depending on the lesion sites of the brain.
Brain ; Deglutition Disorders ; Deglutition* ; Esophagus ; Humans ; Incidence ; Mouth ; Physiology ; Stroke*

OBJECTIVE: To investigate the impact of tracheostomy tube capping on swallowing physiology in stroke patients with dysphagia via videofluoroscopic swallowing study (VFSS). METHODS: This study was conducted as a prospective study that involved 30 stroke patients. Then, 4 mL semisolid swallowing was conducted with capping of the tracheostomy tube or without capping of the tracheostomy tube. The following five parameters were measured: laryngeal elevation, pharyngeal transit time, post-swallow pharyngeal remnant, upper esophageal sphincter width (UES), and penetration-aspiration scale (PAS) score. RESULTS: On assessment of the differences in swallowing parameters during swallowing between ‘with capping’ and ‘without capping’ statuses, statistically significant differences were found in the post-swallow pharyngeal remnant (without capping, 48.19%±28.70%; with capping, 25.09%±19.23%; p<0.001), normalized residue ratio scale for the valleculae (without capping, 0.17±0.12; with capping, 0.09±0.12; p=0.013), normalized residue ratio scale for the piriform sinus (without capping, 0.16±0.12; with capping, 0.10±0.07; p=0.015), and UES width (without capping, 3.32±1.61 mm; with capping, 4.61±1.95 mm; p=0.003). However, there were no statistically significant differences in laryngeal elevation (x-axis without capping, 2.48±1.45 mm; with capping, 3.26±2.37 mm; y-axis without capping, 11.11±5.24 mm; with capping, 12.64±6.16 mm), pharyngeal transit time (without capping, 9.19± 10.14 s; with capping, 9.09±10.21 s), and PAS score (without capping, 4.94±2.83; with capping, 4.18±2.24). CONCLUSION: Tracheostomy tube capping is a useful way to reduce post-swallow remnants and it can be considered an alternative method for alleviating dysphagia in stroke patients who can tolerate tracheostomy tube capping when post-swallow remnants are observed.
Deglutition ; Deglutition Disorders* ; Esophageal Sphincter, Upper ; Fluoroscopy ; Humans ; Methods ; Physiology ; Prospective Studies ; Pyriform Sinus ; Stroke* ; Tracheostomy*

PURPOSE: To determine the effect of a 45degrees reclining sitting posture on swallowing in patients with dysphagia. MATERIALS AND METHODS: Thirty-four patients with dysphagia were evaluated. Videofluoroscopic swallowing study was performed for each patient in 90degrees upright and in 45degrees reclining sitting posture. Patients swallowed 5 types of boluses twice: sequentially 2 mL thin liquid, 5 mL thin liquid, thick liquid, yogurt, and cooked rice. Data such as the penetration-aspiration scale (PAS), oral transit time (OTT), pharyngeal delay time (PDT), pharyngeal transit time (PTT), residue in valleculae and pyriform sinuses, premature bolus loss, and nasal penetration were obtained. RESULTS: The mean PAS on the 2 mL thin liquid decreased significantly in the 45degrees reclining sitting posture (p=0.007). The mean PAS on 5 mL thin liquid in the 45degrees reclining sitting posture showed decreasing tendency. The residue in valleculae decreased significantly for all boluses in the 45degrees reclining sitting posture (p<0.001, p=0.002, p=0.003, p<0.001, p=0.020, respectively). The residue in pyriform sinuses increased significantly on 5 mL thin liquid, thick liquid, and yogurt (p=0.031, p=0.020, p=0.002, respectively). There were no significant differences in OTT, PDT, PTT, premature bolus loss, and nasal penetration between both postures. CONCLUSION: PAS on 2 mL thin liquid and residue in valleculae on all types of boluses were decreased in a 45degrees reclining sitting posture. Therefore, we believe that the 45degrees reclining sitting posture on swallowing is beneficial for the patients with penetration or aspiration on small amounts of thin liquid and large amounts of residue in valleculae.
Adult ; Deglutition/*physiology ; Deglutition Disorders/*physiopathology ; Female ; Fluoroscopy ; Humans ; Male ; Middle Aged ; Patient Positioning ; *Posture

Deglutition ; physiology ; Deglutition Disorders ; physiopathology ; Humans ; Muscles ; physiopathology ; Stroke ; physiopathology ; Viscosity

The main purpose of this paper was to review the role of the hyoid movement in the swallowing process and the effect of swallowing posture, age, gender, bolus properties on the hyoid movement. The displacement of the hyoid bone was divided into vertical and forward displacement. The vertical displacement of the hyoid bone contributes primarily to epiglottic and laryngeal closure, while the anterior displacement contributes primarily to opening of the UES. The dysphagia patients often experienced a reduction in hyoid bone displacement. Therefore, further research on the movement of the hyoid bone in the deglutition, especially the relationship between anterior displacement and UES opening is necessary.
Age Factors ; Deglutition ; physiology ; Deglutition Disorders ; physiopathology ; Epiglottis ; physiology ; Female ; Humans ; Hyoid Bone ; physiology ; Larynx ; physiology ; Male ; Movement ; physiology ; Sex Factors

OBJECTIVETo examine the esophageal function of neonates by high resolution manometry (HRM), and to provide preliminary data for research on the esophageal function of neonates.

METHODSEsophageal HRM was performed on neonates using a solid-state pressure measurement system with 36 circumference sensors arranged at intervals of 0.75 cm, and ManoView software was used to analyze esophageal peristalsis pattern.

RESULTSEsophageal HRM was performed successfully in 11 neonates, and 126 occurrences of complete esophageal peristalsis were recorded. Complete esophageal peristalsis with pressure increase was recorded in some neonates but most neonates showed a different esophageal peristalsis pattern compared with adults. Some neonates had no relaxation of the upper esophageal sphincter (UES) when pharyngeal muscles contracted in swallowing, some neonates had multiple swallowing without esophageal peristalsis and some neonates had relatively low pressure of esophageal peristalsis. Full-term infants could have relatively low UES pressure and esophageal sphincter (LES) pressure but some preterm infants showed relatively high UES pressure and LES pressure. Longitudinal contraction of the whole esophagus and elevation of LES after swallowing were recorded in some neonates.

CONCLUSIONSEsophageal HRM is safe and tolerable for neonates. HRM shows that esophageal peristalsis after swallowing may not occur or may be incomplete in neonates. The esophageal function of neonates has not yet been developed completely, with large individual differences in esophageal peristalsis. Large sample data are needed for further analysis and research on the esophageal function of neonates.

Deglutition ; physiology ; Esophageal Sphincter, Lower ; physiology ; Esophageal Sphincter, Upper ; physiology ; Esophagus ; physiology ; Female ; Humans ; Infant, Newborn ; Male ; Manometry ; methods ; Peristalsis

Swallowing is a rare cause of neurally mediated syncope. The mechanism of swallow syncope that contributes to hypotension, bradycardia, or to both is complex. A 59-year-old man had experienced a recurrent loss of consciousness during swallowing of carbonated beverages or sticky foods. Another 59-year-old man had complained of intermittent syncope just after eating foods. These two patients had no significant structural or functional abnormalities in the esophagus or heart. Both cases showed bradycardia when the lower esophagus was stretched by balloon inflation. The activation of mechanoreceptors in the lower esophagus can be regarded as an initiating factor of these cardioinhibitions. The patients were treated with permanent pacemaker implantation and instructed to change eating habits, respectively.
Bradycardia/etiology ; Deglutition/*physiology ; Esophagus/*innervation ; Humans ; Male ; Mechanoreceptors/*physiology ; Middle Aged ; Syncope/*etiology

Dysphagia is difficulty of effect movement of the bolus from the mouth to the stomach. From and anatomical standpoints, dysphagia is typically classified as oropharyngeal dysphagia (OPD) and esophageal dysphagia (ED). In general, OPD is more highly prevalent condition compared with ED, and associated with severe complications such as malnutrition, dehydration and aspiration pneumonia. These complications are fatal especially in the elderly. Therefore, for preventing severe complications, appropriate and prompt management should be provided to dysphagia patients. However, the decrease of swallowing function is considered as a part of natural aging process. This condition is called as presbyphagia. Although Presbyphagia refers to characteristic changes in the process of swallowing of healthy elderly, it can be a risk factor of dysphagia. With this in mind, for avoiding overdiagnosis or underdiagnosis of dysphagia, we should distinguish among presbyphagia, dysphagia and other related diagnoses. For this reason, understanding about physiology of normal swallowing and natural changes of swallows by aging are essential for physicians. Hence, this review discusses the normal swallow, senile changes of swallow, and dysphagia especially in OPD.
Aged* ; Aging ; Deglutition ; Deglutition Disorders* ; Dehydration ; Diagnosis ; Humans ; Malnutrition ; Medical Overuse ; Mouth ; Physiology ; Pneumonia, Aspiration ; Risk Factors ; Stomach ; Swallows

BACKGROUND AND OBJECTIVES: Studies of normal oropharyngeal swallow in children are essential for the analysis of pediatric dysphagia. The purpose of this study is to define the temporal characteristics of the oropharyngeal swallow in children and to compare these data with young adults. SUBJECTS AND METHOD: This investigation evaluated oropharyngeal swallow physiology during swallows of pudding in 16 children (age 3-13) who had no swallowing complaints including velopharyngeal deficits after surgical treatment of cleft palate and submucous cleft, and 16 normal young adults with no swallowing complaints. temporal analysis of swallow in the children was compared with that of similar temporal measures in the 16 young adults (age 21-29). RESULTS: Temporal measures of pharyngeal swallow events in the children revealed significantly shorter pharyngeal response time, shorter duration of tongue base contact to the posterior pharyngeal wall and longer duration of tongue base posterior movement toward the pharyngeal wall as compared with the normal young adult subjects. CONCLUSION: These differences in the temporal measures of the pharyngeal swallow between children and adults could be the results of differences in the pharyngeal anatomy and the pharyngeal contraction pattern between children and adults. further study of a larger population of normal children is needed.
Adult ; Child* ; Cleft Palate ; Deglutition ; Deglutition Disorders ; Fluoroscopy ; Humans ; Oropharynx ; Physiology ; Reaction Time ; Swallows ; Tongue ; Young Adult

PURPOSE: Studies on the physiology of the transposed stomach as an esophageal substitute in the form of a gastric pull-up or a gastric tube in children are limited. We conducted a study of motility and the pH of gastric esophageal substitutes using manometry and 24-hour pH measurements in 10 such patients. METHODS: Manometry and 24 hour pH studies were performed on 10 children aged 24 to 55 months who had undergone gastric esophageal replacement. RESULTS: Six gastric tubes (4, isoperistaltic; 2, reverse gastric tubes) and 4 gastric pull-ups were studied. Two gastric tubes and 4 gastric pull-ups were transhiatal. Four gastric tubes were retrosternal. The mean of the lowest pH at the midpoint of the substitute was 4.0 (range, 2.8–5.0) and in the stomach remaining below the diaphragm was 3.3 (range, 1.9–4.2). In both types of substitute, the difference between the peak and the nadir pH recorded in the intra-thoracic and the sub-diaphragmatic portion of the stomach was statistically significant (p < 0.05), with the pH in the portion below the diaphragm being lower. The lowest pH values in the substitute and in the remnant stomach were noted mainly in the evening hours whereas the highest pH was noted mainly in the morning hours. All the cases showed a simultaneous rise in the intra-cavitatory pressure along the substitute while swallowing. CONCLUSION: The study suggested a normal gastric circadian rhythm in the gastric esophageal substitute. Mass contractions occurred in response to swallowing. The substitute may be able to effectively clear contents.
Child* ; Circadian Rhythm ; Deglutition ; Diaphragm ; Gastric Stump ; Humans ; Hydrogen-Ion Concentration* ; Manometry* ; Physiology ; Stomach