Pharyngeal Pressure and Timing During Bolus Transit.
Chelsea C Walczak, Corinne A Jones, Timothy M McCulloch
PMID 27565155WHAT IT FOUND
In healthy adults, pressure at the front of a moving liquid bolus was low, while pressure at the back and during clearance was high.
Clearance pressures were greatest at the lower UES. This describes healthy pressure patterns, not a treatment effect.
Key findings
01In healthy adults, pressure at the bolus head was lower than pressure at the bolus tail or clearance in the tongue base, hypopharynx, rostral upper esophageal sphincter, and caudal upper esophageal sphincter.
02The highest clearance pressures occurred at the caudal upper esophageal sphincter.
03At the rostral upper esophageal sphincter, mid-bolus pressure dipped below atmospheric pressure.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Only five male and five female healthy adults were studied, so these pressures may not apply to patients with dysphagia, neurological disease, or older adults. Only 43 swallows were analyzed after exclusions. Videofluoroscopy was limited to 30 frames per second, which may miss fast bolus-head movement. The manometry system averaged pressure around each sensor, so it cannot show which side of the pharynx or which specific muscle generated a pressure. Mid-bolus pressure was taken at one time point only, not across the whole bolus passage. The study did not measure oral cavity pressure, where the bolus began its movement. Some explanations in the Discussion, such as better catheter contact at the caudal upper esophageal sphincter, were not tested.
Declared interests
No conflicts of interest were declared. The article is listed as supported by NIH extramural research.
The easy way to misread this
Do not read these pressure patterns as diagnostic thresholds for dysphagia or as evidence that a treatment works. They were measured only in healthy adults during 10 mL liquid swallows.