Abstract
Literature review on the onset locations of the pharyngeal phase of swallowing in asymptomatic and symptomatic adults and elderly people. Research was conducted in the PubMed, BIREME and SciELO databases through the descriptors fluoroscopy (fluoroscopia), deglutition (deglutição) and pharynx (faringe). Studies published between 2005 and 2015, carried out with adults and elderly people who underwent swallowing videofluoroscopy (SVF), and citing the onset location of the pharyngeal phase of swallowing. Descriptive analysis and meta-analysis were performed, evaluating the heterogeneity and the measures grouped with random effects through I2 statistics. For ratio calculation in the meta-analysis, the locations described in the articles were classified according to the Modified Barium Swallowing protocol - Measurement Tool for Swallowing Impairment (MBSImp). Twelve articles were selected for descriptive analysis and seven for meta-analysis. Heterogeneity was found between studies, especially due to clinical and methodological differences. The random effect indicated predominance (58%) of the onset of the pharyngeal phase of swallowing at levels 0 and 1 of the MBSImP. In asymptomatic individuals, the onset of the pharyngeal phase was observed in the oral cavity, base of the tongue, dorsum of the tongue and vallecula. In symptomatic individuals, onset was mainly observed in the oropharynx, vallecula, hypopharynx and pyriform sinus. We noted a greater frequency of the onset of the pharyngeal phase of swallowing in the vallecula. The onset of the pharyngeal phase in the hypopharynx and pyriform sinus was more often observed among elderly individuals or with comorbidities that could alter swallowing.
Highlights
Swallowing is a physiological process that occurs due to neuromuscular actions involving sensitive cranial nerves, motor and parasympathetic nerves
For the analysis of swallowing, swallowing videofluoroscopy (SVF) can be used, an objective evaluation that is considered the “gold standard”, where it is possible to verify issues related to the anatomy and physiology of swallowing(3)
The absolute and/or relative frequencies of the pharyngeal swallowing phase onset locations were calculated according to the age group, the presence or absence of comorbidities or clinical characteristics that could alter swallowing and the volumes and consistencies offered during SVF examination
Summary
Swallowing is a physiological process that occurs due to neuromuscular actions involving sensitive cranial nerves, motor and parasympathetic nerves. In this phase there is a succession of important, rapid, coordinated and accurate events, such as soft palate elevation, vocal fold closure, pharyngeal muscle contraction, laryngeal elevation and anteriorization and epiglottis lowering These mechanisms occur involuntarily after the stimulation of sensory receptors, especially those located in the oropharyngeal cavity(2,5). The fluidsensitive receptors, according to the author, are located in the paraepiglottic channels It has been observed in some studies(6,12), in which individuals considered asymptomatic, namely, those who do not have underlying diseases and/or clinical characteristics, may present the onset of the pharyngeal phase of swallowing elsewhere in the oropharyngeal tract without physiopathologic implications that indicate risk for laryngeal penetration or aspiration. The lack of consensus is plausible, considering that each swallow is unique in terms of strength, velocity, mobility, range of motion and depends on the volume, taste, viscosity and temperature of the bolus
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