Coordination of deglutitive glottic closure with oropharyngeal swallowing.

The goals of this study were to quantify the temporal relationship between swallow-induced glottic closure and (a) signals of swallow initiation, such as hyoid bone movement, tongue base movement, and mylohyoid electrical activity; (b) pharyngeal peristalsis; (c) laryngeal elevation; (d) vestibular closure; and (e) oropharyngeal barium bolus transit. Eight normal subjects (age 20-30 yr) were studied by concurrent transnasal video laryngoscopy, pharyngeal intraluminal manometry, and submental surface electromyography. The manometric, electromyographic, and both video recordings were synchronized with one another using a specially designed event marker. Dry, 5-ml water, and 5-ml barium swallows were recorded. Frame-by-frame analysis of the video endoscopic recordings showed that deglutitive laryngeal kinetics consisted of vocal cord adduction associated with transverse approximation of the arytenoids followed by vertical approximation of arytenoids to the base of the epiglottis followed by laryngeal ascent and epiglottic descent. Onset of swallow-induced vocal cord adduction preceded the onset of hyoid bone movement, base of the tongue movement, and submental surface myoelectric activity by 0.33 +/- 0.04 (SE) s, 0.31 +/- 0.04 s, and 0.38 +/- 0.04 s, respectively. Onset of vocal cord adduction also preceded the initiation of peristalsis in the nasopharynx and its propagation to oropharynx and upper esophageal sphincter by 0.64 +/- 0.05 s, 0.82 +/- 0.05 s, and 1.08 +/- 0.04 s, respectively. The time between the onset of vocal cord adduction and their return to full opening was 2.2 +/- 0.09 s. It was concluded that (a) among events evaluated, vocal cord adduction is the initial event during the swallowing sequence; (b) laryngeal kinetics during deglutition have distinctive features, and their close coordination with other swallowing events suggests that they are an essential feature of the swallowing program; and (c) abnormal laryngeal kinetics or lack of coordination between the glottic closure mechanism and oropharyngeal bolus transport may have an important role in swallow-induced aspiration.

[1]  F. McConnel,et al.  Quantitative Assessment of Pharyngeal Bolus Driving Forces , 1989, Otolaryngology Head & Neck Surgery.

[2]  C. Sasaki,et al.  Functional anatomy of the larynx. , 1988, Otolaryngologic clinics of North America.

[3]  J. Logemann,et al.  Manual for the videofluorographic study of swallowing , 1986 .

[4]  G. Kelemen,et al.  Physiology of the larynx. , 1955, Physiological reviews.

[5]  A. Dachman,et al.  Timing in the normal pharyngeal swallow. Prospective selection and evaluation of 16 normal asymptomatic patients. , 1984, Investigative radiology.

[6]  M. Griffiths,et al.  Chronic aspiration and laryngeal competence , 1989, The Journal of Laryngology & Otology.

[7]  O. Ekberg Defective closure of the laryngeal vestibule during deglutition. , 1982, Acta oto-laryngologica.

[8]  D. J. Curtis,et al.  Epiglottic motion: video recording of muscular dysfunction. , 1983, Radiology.

[9]  B. Wolf,et al.  Simultaneous cineradiographic and manometric study of the pharynx, hypopharynx, and cervical esophagus. , 1966, Gastroenterology.

[10]  M Suzuki,et al.  Laryngeal reflexes in cat, dog, and man. , 1976, Archives of otolaryngology.

[11]  A. E. Barclay The Normal Mechanism of Swallowing , 1930 .

[12]  J. Logemann Swallowing physiology and pathophysiology. , 1988, Otolaryngologic clinics of North America.

[13]  P J Kahrilas,et al.  Upper esophageal sphincter function during deglutition. , 1988, Gastroenterology.

[14]  E. Miller,et al.  LXXIX The Mechanism of Deglutition (Second Stage) as Revealed by Cine-Radiography , 1951, The Annals of otology, rhinology, and laryngology.

[15]  J. Ogura,et al.  Movements of the vocal cords. , 1968, Acta oto-laryngologica.