Oral Transit Research Articles

Poststroke Dysphagia Rehabilitation by Repetitive Transcranial Magnetic Stimulation: A Noncontrolled Pilot Study

Poststroke dysphagia is frequent and significantly increases patient mortality. In two thirds of cases there is a spontaneous improvement in a few weeks, but in the other third, oropharyngeal dysphagia persists. Repetitive transcranial magnetic stimulation (rTMS) is known to excite or inhibit cortical neurons, depending on stimulation frequency. The aim of this noncontrolled pilot study was to assess the feasibility and the effects of 1-Hz rTMS, known to have an inhibitory effect, on poststroke dysphagia. Seven patients (3 females, age = 65 +/- 10 years), with poststroke dysphagia due to hemispheric or subhemispheric stroke more than 6 months earlier (56 +/- 50 months) diagnosed by videofluoroscopy, participated in the study. rTMS at 1 Hz was applied for 20 min per day every day for 5 days to the healthy hemisphere to decrease transcallosal inhibition. The evaluation was performed using the dysphagia handicap index and videofluoroscopy. The dysphagia handicap index demonstrated that the patients had mild oropharyngeal dysphagia. Initially, the score was 43 +/- 9 of a possible 120 which decreased to 30 +/- 7 (p < 0.05) after rTMS. After rTMS, there was an improvement of swallowing coordination, with a decrease in swallow reaction time for liquids (p = 0.0506) and paste (p < 0.01), although oral transit time, pharyngeal transit time, and laryngeal closure duration were not modified. Aspiration score significantly decreased for liquids (p < 0.05) and residue score decreased for paste (p < 0.05). This pilot study demonstrated that rTMS is feasible in poststroke dysphagia and improves swallowing coordination. Our results now need to be confirmed by a randomized controlled study with a larger patient population.

A Therapeutic Maneuver for Oropharyngeal Dysphagia in Patients with Parkinson’s Disease

OBJECTIVEThis study investigates resources to provide better conditions for oropharyngeal swallowing for improvement in the quality of life of Parkinson’s disease patients.METHODThree men and one woman with an average age of 70.25 years had been afflicted with Parkinson’s disease for an average of 9.25 years. The patients were submitted to a rehabilitation program for oropharyngeal dysphagia after a clinical evaluation of swallowing. The rehabilitation program consisted of daily sessions for two consecutive weeks during which a biofeedback resource adapted especially for this study was used. The patients were then reevaluated for swallowing ability at follow-up.RESULTSThe patients presenting difficulties with swallowing water displayed no such problems after rehabilitation. Only one patient exhibited slow oral transit of food and other discrete oropharyngeal food remnants when swallowing a biscuit. The sample variance was used to analyze the pressure measurements, demonstrating a numerical similarity of the results obtained with the swallowing of saliva or of biscuits (VAR = 4.41). A statistical difference was observed between the swallowing of saliva and biscuits, showing a significant pressure increase at the end of the rehabilitation program (p < 0.001).CONCLUSIONThe effortful swallow maneuver reinforced by using biofeedback appears to be a therapeutic resource in the rehabilitation of oropharyngeal dysphagia in Parkinson’s disease patients.

Pre and post-surgical dysphagia outcome associated with posterior fossa tumour in children

Swallowing impairment (dysphagia) has been reported as a possible sequela following surgical removal of posterior fossa tumours (PFT). Dysphagia may result in aspiration of food/fluid leading to respiratory tract infection, placing the patient at considerable health risk. No prospective studies have investigated dysphagia pre and post-surgical removal of PFT. The present study aimed to document the presence, severity and characteristics of dysphagia pre and post-surgical resection of PFT, and to determine whether children were managing a normal oral diet (i.e. a measure of functional swallowing ability) at two months post-surgery. Dysphagia was assessed using a clinical bedside evaluation in 11 participants (8 M; aged 3 years 6 months to 13 years 5 months) pre (within 3-5 days) and post-surgery (within 1-2 weeks). Return to normal oral feeding was documented at two months post-surgery via a parent telephone interview. No participant had dysphagia pre-surgically. Seventy three percent (8/11) had dysphagia at 1-2 weeks post-surgery, primarily characterized by impaired lip closure (8/8), poor mastication (8/8), and inefficient oral transit (8/8). Whilst dysphagia severity was largely mild (6/8) in presentation, data suggest that assessment and monitoring of this disorder may be required in the acute phase post-surgery. Overall however, prognosis appeared positive, with 75% (6/8) of participants managing a full oral diet at 2 months post-surgery.

Videomanometric Evaluation of Pharyngo‐oesophageal Dysmotility in Children With Velocardiofacial Syndrome

Videomanometric Evaluation of Pharyngo‐oesophageal Dysmotility in Children With Velocardiofacial Syndrome

Swallowing dysfunction in Wilson’s disease: a scintigraphic study

Although dysphagia is a common complaint of patients with Wilson's disease (WD) and pneumonia is an important cause of death in these patients, swallowing function remains an underinvestigated field in this condition. The aim of this study was to characterize swallowing dynamics in WD patients. Eight WD patients and 15 age-matched controls underwent scintigraphic evaluation of oral and pharyngeal deglutition. Patients had significantly slower oral transit (P = 0.008) and a greater percentage of oral residue (P = 0.006) when compared to controls. Two of eight patients were free of neurological symptoms at time of examination. Impaired oropharyngeal function was found in patients without dysphagia and without neurological symptoms. Our findings indicate that WD may present with objective swallowing dysfunction, even in the absence of neurological manifestations. Further studies are necessary to investigate the impact of this dysfunction on morbidity and mortality in WD.

A Scintigraphic Study of Oral, Pharyngeal, and Esophageal Transit in Patients with Stroke

Although stroke affects mainly the oral and pharyngeal phases of swallowing, it may also impair esophageal contractions. Our hypothesis is that stroke may affect esophageal transit. The oral, pharyngeal, and esophageal transit was studied by the scintigraphic method in 26 patients (age range=26-83 years), eight of whom had mild dysphagia but all were able to feed orally and who had suffered an acute first-ever ischemic stroke 10-56 days (median = 43 days) before transit evaluation. The control group included 15 healthy volunteers (age range=27-86 years). All subjects swallowed a 5-ml liquid bolus and a 5-ml paste bolus labeled with technetium-99m phytate while sitting in front of the collimator of a gamma camara. The oral, pharyngeal, and proximal, middle, and distal esophageal transit was measured for 20 s. Three patients did not swallow the bolus during the scintigraphic evaluation. There was no difference between patients and controls with respect to oral and pharyngeal transit or clearance of liquid. For paste, the pharyngeal transit time was shorter for patients (0.48+/-0.17 s) than for controls (0.61+/-0.18 s, p=0.027). Also for the paste bolus, the residue in the mouth was greater in patients (18.4+/-13.6%) than in controls (10.2+/-4.9%, p=0.031). The liquid transit duration in the distal esophagus was shorter in patients with stroke (1.74+/-0.84 s) than in controls (2.68+/-1.65 s, p=0.028). There was no difference between patients and controls in esophageal residue. In conclusion, patients with stroke and able to feed orally may have alterations in the esophageal transit of a liquid bolus.

Defining Swallowing Function by Age

Although it is well known now that age affects swallowing function, few data have been reported for larger bolus sizes, such as 20 mL or sequential cup swallows, and few have reported data on the “oldest old,” or those older than 80 years. The purpose of this investigation was to provide data for future investigations on adults, ranging in age from 21 to older than 100 years, using thin liquid, puree, and solid boluses, ranging from 5 mL to 3 oz, and to add to the database regarding the effects of age, gender, bolus size, and bolus volume on swallowing function. Symptoms relating to swallowing dysfunction were also examined, including the presence of oropharyngeal residue and penetration-aspiration. Having incorporated data on larger swallows from older individuals than in the past and incorporating an 8-point penetration-aspiration scale, several findings emerged in this investigation that have not been clearly defined in prior research as being results of the aging process. Most prominently, it was observed that for older individuals laryngeal penetration is common, often with material remaining in the laryngeal vestibule after the swallow. Differences in oral transit duration and the duration of the onset of the pharyngeal swallow that may result from varying methodologies are also discussed. Implications are drawn for the appropriate evaluation and management of older adults with suspected dysphagia.

Oral and Pharyngeal Transit of a Paste Bolus in Chagas’ Disease

We measured the oral and pharyngeal transit of a paste bolus in 20 patients with Chagas' disease and 21 controls. Each subject swallowed of a 10-ml paste bolus prepared with 50 ml of water and 4.5 g of instant food thickener labeled with 55.5 MBq of 99m technetium phytate. After the scintigraphic recording of the transit, we delineated regions of interest (ROI) corresponding to mouth, pharynx, and proximal esophagus. Time-activity curves were generated for each ROI. There was no difference between patients with Chagas' disease and controls with respect to the duration of oral and pharyngeal transit, amount of pharyngeal residue, or flux of bolus entry into the proximal esophagus. The amount of oral residue was higher in patients with Chagas' disease (median = 0.71 ml) than in controls (median = 0.45 ml). The pharyngeal clearance duration was longer in patients with Chagas' disease (median = 0.85 s) than in controls (median = 0.60 s). The oral transit duration of the patients with Chagas' disease and dysphagia (median = 0.55 s, n = 14) was shorter than the oral transit duration of chagasic patients without dysphagia (median = 0.80 s, n = 6). We conclude that when swallowing a paste bolus, patients with Chagas' disease may have an increased amount of oral residue and a longer pharyngeal clearance duration than asymptomatic volunteers.

The Prediction of Persistent Dysphagia Beyond Six Months After Stroke

The purpose of this study was to identify the videofluoroscopic prognostic factors that affect the recovery of swallowing function at an early stage after stroke and to make a tool for predicting the long-term prognosis. Eighty-three poststroke patients were selected prospectively. These patients had all undergone videofluoroscopic swallowing studies at an average of 40 days after stroke onset and were followed up for over six months. Prognostic factors were determined by logistic regression analysis between the baseline videofluoroscopic findings and aspiration over six months (p < 0.05). A videofluoroscopic dysphagia scale (VDS) with a sum of 100 was made according to the odds ratios of prognostic factors. The validity of the scale was evaluated by using a receiver operating characteristic curve. The VDS was compiled using the following 14 items: lip closure, bolus formation, mastication, apraxia, tongue-to-palate contact, premature bolus loss, oral transit time, triggering of pharyngeal swallow, vallecular residue, laryngeal elevation, pyriform sinus residue, coating of pharyngeal wall, pharyngeal transit time, and aspiration. At a scale cutoff value of 47, the sensitivity was 0.91 and the specificity was 0.92. The VDS was developed to be used as an objective and quantifiable predictor of long-term persistent dysphagia after stroke.

Effects of Bolus Consistency on Timing and Safety of Swallow in Patients with Parkinson’s Disease

Aspiration pneumonia is the leading cause of death in Parkinson's disease (PD) patients. In clinical practice, the videofluoroscopic examination (VFE) is the most common method for evaluation of swallowing disorders. One of the variables manipulated during the VFE is consistency of the bolus. The results of this examination greatly influence the recommendations made by speech-language pathologists regarding swallow therapy and/or intervention. The primary aim of this study was to investigate the effects of bolus consistency on penetration-aspiration (P-A) score and timing of swallow of persons with PD. The videoradiographic images of ten participants with PD swallowing six thin and six pudding-thick boluses were analyzed. Swallow timing and P-A were measured. (i.e., oral transit time, pharyngeal transit time, number of tongue pumps, and P-A score). The results demonstrated various significant differences and relationships among the dependent variables. Implications for further research and clinical practice are discussed.

Effects of Verbal Cue on Bolus Flow During Swallowing

To examine the effects of verbal cuing to initiate swallowing on bolus flow measures in healthy adults. Videofluoroscopic examinations were completed in 12 healthy older adults (median age=69 years) as they swallowed 5 ml of self-administered liquid barium in 2 conditions: verbally cued and noncued swallows. In the cued condition, participants held the liquid in their mouths until instructed to swallow. In the noncued condition, participants swallowed in their usual manner. Verbal cue affected bolus position at onset of timing measures, thereby influencing duration. The bolus was positioned more posterior in the oral cavity at onset of oral transit for cued as compared with noncued swallows. The leading edge of the bolus at onset of the pharyngeal swallow was more superior in the pharynx for cued as compared with noncued swallows. Durations of the cued swallows were significantly shorter than for noncued swallows for all timing measures. Bolus direction scores were not significantly different between conditions. Findings suggest that swallowing is altered by the use of verbal cues to initiate swallowing in healthy adults. Determining whether shorter durations with implementation of verbal cues are evident in individuals with dysphagia and whether effects are beneficial or deleterious requires continued research.

Serial changes in swallowing function in a case of dysphagia after jejunal reconstruction of the cervical esophagus: a case report

The patient was a 56-year-old woman. Cervical esophagectomy for cervical esophageal cancer with preservation of the larynx, bilateral neck dissection, and free jejunum reconstruction were performed in our hospital. The oral and anal sides of the free jejunum were reconstructed by end-to-side anastomosis. The oral-side blind pouch of the free jejunum was long, and the jejunum was atonic. We performed serial swallowing video fluorographic imaging 1 month and 6 months after surgery to quantitatively analyze (1) oral transit and pharyngeal transit time, (2) emptying times of the test diet in the free jejunum, (3) regurgitation of test diet, and (4) the minimal diameter of the free jejunum. At 1 month and 6 months after surgery, oral and pharyngeal transit time were evaluated as normal. Six months after surgery, emptying time of the test diet in the free jejunum was reduced compared with that 1 month after surgery. Six months after surgery, regurgitation of test diet from the blind pouch had decreased by approximately 36% compared with that at 1 month after surgery. Furthermore, 6 months after surgery, motility of the transferred jejunum had improved compared with that 1 month after surgery. These findings suggested that the food-transporting activity of the free jejunum recovered over time; however, the blind pouch length should be made as short as possible, and the jejunum should be anastomosed in a stretched position from the perspective of swallowing function.

Assessment of Swallowing by Oropharyngoesophageal Scintigraphy in Patients with Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is the most common degenerative motor neuron disease in adults, and dysphagia is one of its most frequent and disabling symptoms. Oropharyngoesophageal scintigraphy (OPES) permits a functional and semiquantitative study of the various stages of swallowing. We studied 28 ALS patients (12 females and 16 males; mean age = 63.57 +/- 10.39 yr SD), who were clinically rated against the ALSFRS scale (Amyotrophic Lateral Sclerosis Functioning Rating Scale) and underwent OPES with (99m)Tc-nanocolloid using either a liquid or a semisolid bolus. The semiquantitative parameters we analyzed were Oral Transit Time (OTT), Pharyngeal Transit Time (PTT), Esophageal Transit Time (ETT), Retention Index (RI), and Esophageal Emptying Rate (EER(10s)). Hence, the OPES performed with a semisolid bolus produced a higher proportion of pathologic values for the swallowing variables than when liquid bolus was used. Analyzed by grouping the patients into classes according to their bulbar ALSFRS scores, we found a significant increase in the OTT (p < 0.005), PTT (p < 0.02), and Oropharyngeal Retention Index (OPRI) (p < 0.0004) variables in ALS patients with more severe bulbar involvement. OPES has turned out to be a very important examination for detecting tracheal-bronchial inhalation and it also offers the possibility of acquiring a semiquantitative evaluation of the amount of food inhaled. In our experience, OPES in patients with ALS has been easy to use, economic, well tolerated, and capable of supplying precise indications with regard to the extent of the swallowing disorder, which permits a better clinical definition of the ALS patient.

Pre-emptive swallowing stimulation in long-term intubated patients

Objective: To evaluate the effect of pre-emptive swallowing stimulation on the recovery of swallowing function in long-term intubated patients. Design and subjects: Patients in the intensive care unit intubated for at least 48 hours due to respiratory distress from March to August 2004 were randomly divided into two groups. Fifteen patients of mean age 55.39±17.9 years were stimulated (experimental group) and 18 patients of mean age 61.39±13.5 years were not stimulated (control group). The duration of intubation was 15.59±6.7 days in the experimental group and 15.79±6.5 days in the control group. Duration of stimulation in the experimental group was 7.39±3.6 days. After extubation, we compared the severity of dysphagia via video-fluoroscopic swallow study. Results: There were no statistically significant differences in the percentage of aspiration and the swallowed volume between the two groups. However, oral transit time in the experimental group (0.379±0.07 seconds) was significantly shorter than that of the control group (0.839±0.10 seconds), and the oropharyngeal swallowing efficiency of the experimental group (73.39±17.4%/s) was significantly higher than that of the control group (50.19±13.0%/s). Conclusion: Pre-emptive swallowing stimulation during intubation assists in the recovery of swallowing function in long-term intubated patients.

Evolución de la aspiración laringo-traqueal en la disfagia orofaríngea secundaria a lesión cerebral traumática: cuantificación videofluoroscópica

Swallowing impairments are frequent after severe traumatic brain injury (TBI). to define and prospectively quantify the videofluoroscopic symptoms in patients after TBI, and to evaluate the evolution of patients with laryngotracheal aspiration. We studied 10 patients with TBI, and a clinical suspicion of aspiration confirmed by means of a videofluoroscopic exploration (VDF). VDF was repeated at 1, 3, 6, and 12 months thereafter. 30% of patients had an impaired gag reflex, and 40% cough during oral feeding. In the first VDF exploration the following was observed: increased oral transit time (OTT) in 70% (average: 3.8 sec.; range: 0.8-15 sec.), altered lingual control in 60%, and dysfunctional palatoglossal closure in 20%. Mean pharyngeal transit time (PTT) was 0.72 sec. (range: 0.34-1.50 sec.), and time to swallowing reflex (TSR) was 0.32 sec. (range: 0.10-0.80 sec.). After one year only 3 patients had aspiration--with a normal OTT in 7 patients, a normal PTT in 9, and a normal TSR in all; 80% had an exclusively oral diet, and 20% combined oral intake and gastrostomy feeding. Videofluoroscopic evaluation allows to confirm and quantite swallowing dysfunction in patients with severe TBI. Most frequent early findings included an increase in OTT and alterations in lingual control; aspirations were quite frequent, and more than half were silent. After one year the majority of patients showed a favorable outcome.

The Effect of Nasogastric Tubes on Swallowing Function in Persons With Dysphagia Following Stroke

Wang T-G, Wu M-C, Chang Y-C, Hsiao T-Y, Lien I-N. The effect of nasogastric tubes on swallowing function in persons with dysphagia following stroke. Objective To determine whether the use of a nasogastric tube influences swallowing function in stroke patients with dysphagia. Design Before-after trial. Setting Primary care center. Participants A total of 22 patients with stroke (12 men, 10 women; mean age, 69.7y; range, 19−85y) participated in the study. Time from onset of stroke to time of assessment averaged 20.3 days (range, 14−38d). All participants continued to use a nasogastric tube for nutrition supply and had either minor or no aspiration of barium on videofluoroscopic examination of swallowing (VFES). Intervention The swallowing function was evaluated by VFES with thin and thick bariums (5mL each) as a contrast medium. Main Outcome Measures The oral transit, swallowing trigger, and pharyngeal transit times were measured and compared before and after the removal of the nasogastric tube. The patients were also observed for changes in velopharyngeal closure, pharyngeal contraction, epiglottic tilt, valleculae stasis, pyriform sinus stasis, penetration, and aspiration. Results Transit times were reduced by 0.2 to 0.6 seconds after removal of the nasogastric tube, but the reduction was not statistically significant. These transit times were slightly longer with thick barium than with thin barium, but were without statistical significance. Similarly, most of the patients had no change in nontemporal assessment of swallowing function after the tube was removed. Conclusions The placement of a nasogastric tube did not affect temporal and nontemporal measurement of swallowing in stroke patients with dysphagia with or without minor aspiration.

Cough in specific populations (paediatric patients, elderly patients and patients with underlying disease)

Cough in specific populations (paediatric patients, elderly patients and patients with underlying disease)

Clinical Validity of the SWAL-QOL and SWAL-CARE Outcome Tools with Respect to Bolus Flow Measures

The aim of this study was to quantify the association between a dysphagia-specific quality of life (SWAL-QOL) and quality of care (SWAL-CARE) questionnaire and four measures of bolus flow. Three hundred eighty-six people with oropharyngeal dysphagia completed a videofluoroscopic examination of their swallowing structure and physiology. They also completed the SWAL-QOL and SWAL-CARE surveys. Measures of bolus flow patterns for each swallow were analyzed from videofluoroscopic recordings and correlated with the SWAL-QOL and SWAL-CARE scale scores. The SWAL-QOL and SWAL-CARE scales were modestly related to the four measures of the bolus flow. The SWAL-QOL and SWAL-CARE were most related to measures of oral transit duration and total swallow duration. The SWAL-QOL and SWAL-CARE scales were least related to pharyngeal transit duration. Results were stronger for semisolid trials than for liquid trials. Results were generally weak for the Penetration Aspiration Scale. For all of the significant relationships, the greater the bolus flow severity, the worse the quality of life. The observed modest correlations suggest that patient-centered quality-of-life measures and clinician-driven bolus flow measures provide distinct yet complementary information about oropharyngeal dysphagia. Both sets of measures should be used in dysphagia effectiveness and outcomes research.

Do All Patients with Small Intestinal Bacterial Overgrowth (SIBO), Based on a Double Peaked Lactulose Breath Test (DPLBT), Need Antibiotics or Is Tegaserod an Option?

Purpose: The goal of our clinical evaluation was to see the effects of tegaserod on patients who presented with constipation and bloating and were found to have a DPLBT. The lactulose breath test (LBT) uses a non absorbed disaccharide broken down by bacterial colonies normally encountered in the cecum. The LBT can be used to identify patients with SIBO based on the presence of a DPLBT, signifying an abnormal proximal location of bacteria. A 72 year old female diabetic patient had resolution of her significant constipation and bloating as well as normalization of her DPLBT while taking tegaserod. She had been previously given a 14 day course of ciprofloxacin and metronidazole and had a transient resolution of her DPLBT; however, her symptoms recurred within 6 months. She refused a second course of antibiotics, and we opted to start tegaserod 6 mg po bid. She sustained resolution of her DPLBT and her clinical symptoms within 2 weeks. Methods: Patients with the clinical syndrome of constipation predominant IBS (IBS-C) based on Rome II criteria were evaluated with LBT. Five female patients (ages 53 – 65) manifested a DPLBT and underwent a trial of tegaserod. None of these patients had any clinical history to suggest dysmotility i.e. diabetes, calcium channel blockers, or evidence of mechanical obstruction based on UGI/SBFT and colonoscopy. After 2 weeks, a repeat LBT and clinical evaluation was performed Results: Four responded to a 2 week trial of tegaserod 6mg bid with resolution of the DPLBT accompanied by significant symptomatic relief. The fifth patient discontinued tegaserod on the third day due to cramps and diarrhea and did not repeat the LBT. All 4 patients with IBS-C and DPLBT who completed the 2 week trial of tegaserod had clinical improvement and normalization of the LBT. The double peak disappeared and the oral cecal transit time (OCTT) was reduced from a mean of 143 minutes (range 120 – 150) to 79 (range 60 – 90). Conclusions: Patients with an abnormal LBT consistent with SIBO may be relieved with antibiotics. The LBT is an indirect evaluation, yet a clinical response and a normalization of an abnormal test cannot be ignored. Tegaserod, a prokinetic, may alter the findings on LBT, as it is known to decrease the OCTT, and may provide a more physiologic therapy for a selective subgroup of IBS-C

Aspects of Swallowing in Healthy Dentate Elderly Persons Older Than 80 Years

Although age-related changes resulting in slowing of the swallowing reflex and a decline in the neuromuscular control system have been reported, there have been few reports on swallowing function in dentate elderly persons. The purpose of this study was to clarify the primary influence of aging on swallowing in healthy dentate elderly persons older than 80 years who have more than 20 teeth. Dentate elderly persons (12 male, 7 female; mean age: 81.2 years) and dentate young participants (9 male, 5 female; mean age: 26.8 years) as a control group participated voluntarily. Participants reported no clinical symptoms relating to dysphagia, neurologic impairments, or degenerative diseases, and were asked to swallow 10 ml of barium sulfate solution (10% w/v) three times. Functional swallowing was recorded on 35 mm cinefilm at 30 frames per second with a digital subtraction angiography system. Lateral images of cinefluorography of seated participants' mouth, pharynx, and larynx were obtained. Visual image analysis for qualitative and quantitative evaluation was made with a cine projector. No participants exhibited aspiration during three trials. Occurrence and frequencies of piecemeal deglutition, premature loss of liquid, oral and pharyngeal residues, and laryngeal penetration were significantly greater in dentate elderly persons (p <.05) than in the dentate young participants. Oral transit time, pharyngeal delay time, and pharyngeal transit time in dentate elderly persons were prolonged significantly compared with those in dentate young participants (p <.01). Physiological swallowing functions deteriorate even in healthy dentate elderly persons. This deterioration may be explained primarily by the influence of aging on swallowing.