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Effects of Head Rotation and Head Tilt on Pharyngeal Pressure Events Using High Resolution Manometry.

Kim CK, Ryu JS, Song SH, Koo JH, Lee KD, Park HS, Oh Y, Min K - Ann Rehabil Med (2015)

Bottom Line: The data obtained for these two postures were compared with those obtained from the neutral posture.The changes in the VP peak and epiglottis, VP and TB peaks, and the VP onset and post-UES time intervals were significant in head tilting and head rotation toward the catheter postures, as compared with neutral posture.The pharyngeal pressure and time parameter analysis using HRM determined the availability of head rotation as a compensatory technique for safe swallowing.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

ABSTRACT

Objective: To observe changes in pharyngeal pressure during the swallowing process according to postures in normal individuals using high-resolution manometry (HRM).

Methods: Ten healthy volunteers drank 5 mL of water twice while sitting in a neutral posture. Thereafter, they drank the same amount of water twice in the head rotation and head tilting postures. The pressure and time during the deglutition process for each posture were measured with HRM. The data obtained for these two postures were compared with those obtained from the neutral posture.

Results: The maximum pressure, area, rise time, and duration in velopharynx (VP) and tongue base (TB) were not affected by changes in posture. In comparison, the maximum pressure and the pre-upper esophageal sphincter (UES) maximum pressure of the lower pharynx in the counter-catheter head rotation posture were lower than those in the neutral posture. The lower pharynx pressure in the catheter head tilting posture was higher than that in the counter-catheter head tilting. The changes in the VP peak and epiglottis, VP and TB peaks, and the VP onset and post-UES time intervals were significant in head tilting and head rotation toward the catheter postures, as compared with neutral posture.

Conclusion: The pharyngeal pressure and time parameter analysis using HRM determined the availability of head rotation as a compensatory technique for safe swallowing. Tilting the head smoothes the progress of food by increasing the pressure in the pharynx.

No MeSH data available.


Related in: MedlinePlus

The epiglottic tilting peak at 1 level higher or lower to epiglottis level as a tongue base pressure (A), low pharyngeal peristaltic shallow and peristaltic peak between TB and UES (B), pre-UES peak (C), and post-UES peak (D). TB, tongue base; UES, upper esophageal sphincter.
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Figure 1: The epiglottic tilting peak at 1 level higher or lower to epiglottis level as a tongue base pressure (A), low pharyngeal peristaltic shallow and peristaltic peak between TB and UES (B), pre-UES peak (C), and post-UES peak (D). TB, tongue base; UES, upper esophageal sphincter.

Mentions: The VP, TB, and UES were defined manometrically as in McCulloch et al. [12]. The VP was defined as the area of the pressure changes associated with proximal swallowing immediately extending 2 cm beyond nasal continuous stationary area. The TB pressure was located anatomically at the same level as the epiglottis. The tilted epiglottis strikes the manometric catheter, thus tilting and epiglottis tilting results in changes s in the peak pressure and area. Therefore, we measured the higher pressure peak at 1 level higher or lower than the epiglottis level, as the tongue base pressure. The LP peak was measured between the TB and the UES. This peak was shallow and peristaltic. The UES peak was broad, and located 1 channel below the LP peak. Therefore the LP peak represented the inferior pharyngeal constrictor and the UES peak represented the cricopharyngeus muscles (Fig. 1).


Effects of Head Rotation and Head Tilt on Pharyngeal Pressure Events Using High Resolution Manometry.

Kim CK, Ryu JS, Song SH, Koo JH, Lee KD, Park HS, Oh Y, Min K - Ann Rehabil Med (2015)

The epiglottic tilting peak at 1 level higher or lower to epiglottis level as a tongue base pressure (A), low pharyngeal peristaltic shallow and peristaltic peak between TB and UES (B), pre-UES peak (C), and post-UES peak (D). TB, tongue base; UES, upper esophageal sphincter.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496514&req=5

Figure 1: The epiglottic tilting peak at 1 level higher or lower to epiglottis level as a tongue base pressure (A), low pharyngeal peristaltic shallow and peristaltic peak between TB and UES (B), pre-UES peak (C), and post-UES peak (D). TB, tongue base; UES, upper esophageal sphincter.
Mentions: The VP, TB, and UES were defined manometrically as in McCulloch et al. [12]. The VP was defined as the area of the pressure changes associated with proximal swallowing immediately extending 2 cm beyond nasal continuous stationary area. The TB pressure was located anatomically at the same level as the epiglottis. The tilted epiglottis strikes the manometric catheter, thus tilting and epiglottis tilting results in changes s in the peak pressure and area. Therefore, we measured the higher pressure peak at 1 level higher or lower than the epiglottis level, as the tongue base pressure. The LP peak was measured between the TB and the UES. This peak was shallow and peristaltic. The UES peak was broad, and located 1 channel below the LP peak. Therefore the LP peak represented the inferior pharyngeal constrictor and the UES peak represented the cricopharyngeus muscles (Fig. 1).

Bottom Line: The data obtained for these two postures were compared with those obtained from the neutral posture.The changes in the VP peak and epiglottis, VP and TB peaks, and the VP onset and post-UES time intervals were significant in head tilting and head rotation toward the catheter postures, as compared with neutral posture.The pharyngeal pressure and time parameter analysis using HRM determined the availability of head rotation as a compensatory technique for safe swallowing.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

ABSTRACT

Objective: To observe changes in pharyngeal pressure during the swallowing process according to postures in normal individuals using high-resolution manometry (HRM).

Methods: Ten healthy volunteers drank 5 mL of water twice while sitting in a neutral posture. Thereafter, they drank the same amount of water twice in the head rotation and head tilting postures. The pressure and time during the deglutition process for each posture were measured with HRM. The data obtained for these two postures were compared with those obtained from the neutral posture.

Results: The maximum pressure, area, rise time, and duration in velopharynx (VP) and tongue base (TB) were not affected by changes in posture. In comparison, the maximum pressure and the pre-upper esophageal sphincter (UES) maximum pressure of the lower pharynx in the counter-catheter head rotation posture were lower than those in the neutral posture. The lower pharynx pressure in the catheter head tilting posture was higher than that in the counter-catheter head tilting. The changes in the VP peak and epiglottis, VP and TB peaks, and the VP onset and post-UES time intervals were significant in head tilting and head rotation toward the catheter postures, as compared with neutral posture.

Conclusion: The pharyngeal pressure and time parameter analysis using HRM determined the availability of head rotation as a compensatory technique for safe swallowing. Tilting the head smoothes the progress of food by increasing the pressure in the pharynx.

No MeSH data available.


Related in: MedlinePlus