Pharyngeal Lumen Research Articles

Solitary Isolated Oropharyngeal Neurofibroma Presenting With Dysphagia in the Setting of Von Recklinghausen's Disease.

A 24-year-old man with von Recklinghausen's disease presented with complaints of difficulty in swallowing for 6 months and change of voice for 3 months. He also had recent-onset difficulty in breathing. Telelaryngoscopy and subsequent contrast-enhanced computed tomography scan revealed a well-defined, smooth submucosal mass in the oropharynx (attached to the posterior pharyngeal wall, superior to the level of left aryepiglottic fold), obscuring the ipsilateral pyriform fossa, and nearly blocking the pharyngeal lumen. The mass was removed with endoscopic coblation-assisted laryngeal surgery, and subsequent histopathology revealed it to be neurofibroma. Neurofibromas are rare neoplasms to be encountered in the oropharynx. However, in the setting of von Recklinghausen's disease (neurofibromatosis type 1), one or more well-demarcated, submucosal nodular lesions in the upper aerodigestive tract may be considered as neurofibromas, and workup and treatment should be directed accordingly based on this clinical presumption. Endoscopic coblation during laryngeal surgery can effectively be used as a surgical tool to excise such lesions. It provides a relatively bloodless field compared to the conventional cold steel excision, and reduces the risk of complications at surgery and during the follow-up period. This clinical record illustrates the presentation and management of a solitary, isolated oropharyngeal neurofibroma in a man suffering from von Recklinghausen's disease. It further emphasizes the role of endoscopic coblation-assisted laryngeal surgery in this setup, and the need to maintain a low threshold of suspicion in having a provisional clinical diagnosis of such lesions.

Symptomatic vallecular cyst

We report the case of a 32-year-old man suffering from a progressive dysphagia 4 months ago, who was seen in an ENT consultation and whose endoscopic examination showed a large shiny formation at the base of the tongue, considerably reducing the pharyngeal lumen. Cervical computed tomography (CT) showed a homogeneous cystic formation filling the vallecula and pushing down the epiglottis. The patient was diagnosed with vallecular cyst (Figure 1). The treatment was endoscopic, with marsupialization of the cyst after aspiration of its contents.

Foreign body of the thyroid gland

A rare case of thyroid foreign body is presented. The swallowed fish bone perforated the pharyngeal wall and migrated to the thyroid gland. The rarity of pathology caused diagnostic difficulties. Despite the correct diagnosis, wait-and-see tactics was initially chosen that delayed surgery and contributed to tissue inflammation. The stages of therapeutic and diagnostic process are analyzed. Endoscopy is not always effective, especially when foreign body migrates from pharyngeal lumen into soft tissues. Ultrasound and CT are necessary for topical diagnosis of migrated foreign body. These methods revealed fish bone migration towards cervical vascular bundle and local complications. Literature data and own experience are analyzed. Early surgical treatment guarantees good results and rapid rehabilitation.

The Species Diversity Assessment of Azygia Looss, 1899 (Digenea: Azygiidae) from the Volga, Ob, and Artyomovka Rivers Basins (Russia), with Description of A. sibirica n. sp.

This study is devoted to the investigation of Azygia (Digenea: Azygiidae) species diversity using classical morphological, recent molecular tools (28S rRNA and cox1 mtDNA for genetic-based inference) and robust statistical techniques (Principal component analysis, PCA). The analysis revealed that the genus Azygia included four valid species: A. lucii, A. longa, A. hwangtsiyui, and A. sibirica n. sp. The distribution of the type species A. lucii was confirmed in the largest Russian rivers: the Volga and the Ob. The worms isolated from Perccottus glenii were determined as the Chinese species A. hwangtsiyui, according to the genetic data for the cox1 mtDNA gene, at 1.32–1.56%. The new species, Azygia sibirica n. sp, was described from Esox lucius in the Ob River and differentiated from the type species A. lucii by the smaller ovary, testes and prostatic sac, wider body, very narrow pharyngeal lumen and form of anterior margin of ovary. In addition, multivariate analysis and three methods for species delimitation (ABGD, GMYC, bPTP) showed the subdivision of A. lucii and A. sibirica n. sp. into two separate groups, one from the Volga River and another from the Ob River, respectively. To conclude, A. lucii infects Esox lucius in the western (European part of Russia, the Volga River basin), and northern (Western Siberia, the Ob River basin) parts of Russia; A. sibirica n. sp. has also been found to infect Esox lucius in the Ob River, while A. hwangtsiyui infects Perccottus glenii in the South of the Russian Far East (the Artymovka River basin).

Conventional imaging is useful for assessment of equine pharyngeal squamous cell carcinoma but underestimates bone involvement

SummaryBackgroundSquamous cell carcinoma is the most common pharyngeal neoplasm but is poorly documented with diagnostic imaging in veterinary literature.ObjectivesTo describe the diagnostic imaging findings in horses with confirmed pharyngeal squamous cell carcinoma.Study designRetrospective case series.MethodsHorses with a definitive diagnosis of pharyngeal squamous cell carcinoma based on in situ biopsy and/or cytology were identified in 2 different centres. Multi‐modality imaging findings are reported.ResultsSix equids were included. On radiographic examination, increased pharyngeal opacity and reduction of pharyngeal lumen were observed in all horses, centred on the oropharynx (three cases), the laryngopharynx (two cases) or the nasopharynx (one case). A clearly delineated mass was visualised in four cases. Additional radiographic findings were border effacement of the epiglottis (5/6) or soft palate (3/6), thickening of the pharyngeal walls (4/6) or soft palate (3/6) and suspected retropharyngeal lymphadenomegaly (3/6). Ultrasonography was useful to highlight retropharyngeal (4/6) and mandibular (4/6) lymphadenopathy suggestive of metastatic dissemination. Computed tomographic images were available for two horses and detected bone lysis not visible on radiographs.Main limitationsThe number of cases was low, and computed tomography was not realised in all cases.ConclusionsFindings support the usefulness of radiography and ultrasonography in horses with suspected pharyngeal neoplasia for a first‐line imaging diagnosis, in particular when endoscopy is impaired by a mass effect or dyspnoea. Computed tomography gives a more accurate assessment of bone involvement.

Toxicological Impact and in Vivo Tracing of Rhodamine Functionalised ZIF-8 Nanoparticles.

Metal Organic Frameworks (MOFs) are extensively used for a wide range of applications due to their exceptionally high surface area. MOF particles are conventionally in micron size, but the nanosized MOFs show good transportation/mobility due to their small size, and when combined with the high surface area of MOFs, it makes MOF nanoparticles an ideal candidate to study for environmental remediation. Therefore, it is important to study the ecotoxicological impact of these MOFs. In this study, we developed rhodamine labelled nanoparticles of zinc imidazolate metal organic framework (ZIF-8 MOFs) as a means of in vivo tracing the MOF translocation in C. elegans. Rhodamine B isothiocyanate functionalized ZIF-8 MOFs nanoparticles (RBITC@ZIF-8 MOF nanoparticles; size 44 ± 7 nm) were fed to the worms naturally within a concentration range of 0.16–16.4 μg mg−1. Fluorescence was detected in the pharyngeal and gut lumen regions of the worms after 4 h of treatment, for exposure concentrations >0.163 μg mg−1. A higher intensity of fluorescence was observed at the end of 24 h for all exposure concentrations. Worms treated with RBITC@ZIF-8 MOF concentrations of ≥1.63 μg mg−1 for 24 h showed a bright stable fluorescence signal at the tail region. The uptake of RBITC@ZIF-8 MOF for an exposure concentration of 0.163, 1.63, and 8.2 μg mg−1 was found to be 52.1, 11.4 and 28.6%, respectively. Through this study, we showed that RBITC@ZIF-8 MOFs can be exposed to C. elegans and imaged at low concentrations of ∼0.16 μg mg−1.

Longitudinal dysphagia assessment in adult patients with nephropathic cystinosis using the Modified Barium Swallow Impairment Profile.

Nephropathic cystinosis is a lysosomal storage disorder with known myopathic features, including dysphagia. Evaluation of oropharyngeal swallowing physiology can be standardized using the Modified Barium Swallow Impairment Profile (MBSImP), a validated assessment tool used to analyze and rate swallowing across 17 distinct physiologic domains. Our objective was to better characterize swallowing impairments in nephropathic cystinosis using MBSImP analysis. We retrospectively evaluated 40 video fluoroscopic swallowing studies performed at two time points over 1y in patients with nephropathic cystinosis with various levels of oral and pharyngeal stage dysphagia. Patients completed two self-administered dysphagia outcome measures (the M. D. Anderson Dysphagia Inventory [MDADI] and the 10-item Eating Assessment Tool [EAT-10]). We demonstrated oral stage and pharyngeal stage dysphagia across domains that impacted bolus control, transit, and clearance through both the oral cavity and pharyngeal lumen. Also captured were deficits related to onset and completeness of laryngeal closure that impact airway protection during swallow. There were significant correlations between pharyngeal total score and EAT-10 (r= 0.5, p< 0.001) and between oral total score and EAT-10 (r= 0.7, p< 0.001), MDADI-e (r= -0.6, p< 0.001), MDADI-p (r= -0.5, p< 0.001) and MDADI-c (r= -0.6, p< 0.001). There were no differences in oral or pharyngeal total scores across the 1-y time span. This study identifies oral and pharyngeal stage dysphagia as crucial to patients with nephropathic cystinosis and paves the path for future studies of treatment targets.

Nasopharyngeal collapse can be identified on radiography in healthy male Beagle dogs without cardiopulmonary diseases.

Pharyngeal collapse has been described as a decrease of more than 50% in the diameter of the lumen. However, there has been no study on changes in the pharyngeal lumen in clinically normal dogs. The hypothesis of this prospective, observational, and pilot study was that change in nasopharyngeal lumen would be over 50% in Beagle dogs without cardiopulmonary diseases. Thus, we assessed the nasopharyngeal luminal change using cervical radiography in Beagle dogs without respiratory signs or cardiac abnormalities. The study sample included 42 Beagle dogs without cardiopulmonary diseases. Cervical radiographies were acquired during inspiration and expiration, and nasopharyngeal luminal change (%) was calculated. The median nasopharyngeal luminal change was 16.6%, and nasopharyngeal luminal change over 50% was identified in two dogs. The nasopharyngeal luminal change was significantly associated with body condition score and body weight. There was no correlation between nasopharyngeal luminal change and age. This study revealed that change in nasopharyngeal lumen over 50% can be identified in Beagle dogs without cardiopulmonary diseases and may be over-diagnosed as partial pharyngeal collapse. Further studies for comparing change in nasopharyngeal lumen between clinically normal dogs and dogs with respiratory signs are warranted.

Acoustic parameter changes after bariatric surgery

Objective To investigate the acoustic parameter changes after weight loss in bariatric surgery patients. Materials and methods This prospective, longitudinal study was conducted with 15 patients with planned bariatric surgery, who were evaluated pre-operatively and at 6 months post-operatively. Fundamental frequency (F0), Formant frequency (F1, F2, F3, and F4), Frequency perturbation (Jitter), Amplitude perturbation (Shimmer) and Noise-to-Harmonics Ratio (NHR) parameters were evaluated for /a/, /e/, /i/, /o/, and /u/ vowels. Changes in the acoustic analysis parameters for each vowel were compared. The study group was separated into two groups according to whether the Mallampati score had not changed (Group 1) or had decreased (Group 2) and changes in the formant frequencies were compared between these groups. Results A total of 15 patients with a median age of 40 ± 11 years completed the study. The median weight of the patients was 122 ± 14 kg pre-operatively and 80 ± 15 kg, post-operatively. BMI declined from 46 ± 4 to 31 ± 5 kg/m2. The Mallampati score decreased by one point in six patients and remained stable in nine. Of the acoustic voice analysis parameters of vowels, in general, fundamental frequency tended to decrease, and shimmer and jitter values tended to increase. Some of the formant frequencies were specifically affected by the weight loss and this showed statistical significance between Group 1 and Group 2. Conclusion The present study reveals that some specific voice characteristics might be affected by successful weight loss after bariatric surgery. Highlights Obesity reduces the size of the pharyngeal lumen at different levels. The supralaryngeal vocal tract size and configuration is a determinative factor in the features of the voice. Changes in the length and shape of the vocal tract, or height and position of the tongue can result in changes especially in formant frequencies in acoustic analysis.

Age-related composition changes in swallowing-related muscles: a Dixon MRI study.

Dysphagia is considered a social problem in the super-aging society. However, age-related changes in swallowing-related muscles have not been fully deciphered. We aimed to identify intramuscular fatty infiltration and muscle atrophy in multiple swallowing-related muscles on magnetic resonance imaging (MRI). Moreover, an appropriate muscle strength parameter for the evaluation of swallowing-related muscle mass was examined. We analyzed the Dixon MRI results of 20 elderly and 20 young adults without head and neck cancer, stroke, neuromuscular disease, or whole-body sarcopenia to evaluate intramuscular fatty infiltration (IMF) and lean muscle mass (LMM) in the tongue, geniohyoid, and pharyngeal muscles. The pharyngeal lumen size was also assessed. Tongue pressure, jaw-opening strength, occlusal force, and head-lifting strength were evaluated within a week before and after MRI. Aging significantly affected the IMF of the swallowing-related muscles, and the tongue muscle was most affected, followed by the pharyngeal muscle and then the geniohyoid muscle. Only the LMM of the geniohyoid muscle significantly decreased with aging. The pharyngeal lumen size did not significantly differ between the elderly and young participants, and only tongue pressure was significantly correlated with tongue, geniohyoid, and pharyngeal muscle mass. IMF is primarily associated with age-related composition changes in swallowing-related muscles, and it is commonly observed in the tongue and pharyngeal muscles. The geniohyoid muscle is more at risk of muscle atrophy rather than fatty infiltration. In addition, tongue pressure can be a parameter for the evaluation of swallowing-related muscle mass.

Radiotherapy of extraosseous nasopharyngeal chordoma: A case report and literature review

Chordomas are slow-growing aggressive tumors that account for 1-4% of all bone tumors. The anatomical distribution of chordomas includes 50-60% in the sacrococcygeal region, 25-30% in the skull base and 15% in the mobile spine. Virchow was the first to describe and term these tumors as ‘ecchordosis physaliphora’ in 1857, and Muller established their notochordal origin in 1895. Extraosseous chordomas of the nasopharynx are very rare, and they exhibit similarities with other lesions of the nasopharynx, presenting as a soft tissue mass. Gross total resection combined with postoperative radiotherapy offers the best chance of long-term control. We herein present the case of a 63-year-old female patient with complaints of left temporal headaches, dizziness, left nasal obstruction, left maxillary area numbness, left ear hearing loss and swallowing difficulty. Computed tomography imaging examination revealed an 8.2x3.2x5.7-cm space-occupying lesion with central necrosis in the nasopharynx and oropharynx, partially occluding the pharyngeal lumen; the mass had infiltrated the left parapharyngeal space, the left medial and lateral pterygoid muscle and the left parotid gland, with bone erosion of the left mandible. The patient was diagnosed with extraosseous chordoma of the nasopharynx, conventional type, stage IIB. The patient underwent surgery and high-dose radiotherapy and local control of the chordoma was achieved. However, the patient succumbed to a lung metastasis. The details of the case are discussed, and a review of the current medical literature is presented to provide an updated discussion on the current status of nasopharyngeal chordoma research.

Evaluation of Dynamic Structural Disorders in the Upper Airways and Applied Rein Tension in Healthy Dressage Horses During Riding in Different Gaits and Head–Neck Positions

Flexion of the horse’s head and neck during dressage riding reduces the pharyngeal lumen with the risk of increased upper airway resistance and upper airway obstructions. According to the Fédération Equestre Internationale, hyperflexion is achieved through force, whereas the position low–deep–round is nonforced. The objectives of this study were to evaluate (1) applied rein tension and (2) dynamic structural disorders in the upper airways in dressage horses in different gaits and different head–neck positions (HNPs). Overground endoscopy (OGE) and rein tension were evaluated in 13 clinically healthy and high-performance Warmblood dressage horses while being ridden in a standardized program comprised of four different gaits (halt, walk, trot, and canter) and in four HNPs (unrestrained, competition frame, hyperflexion, and low–deep–round). All included horses were able to achieve the desired HNPs. The HNP low–deep–round showed significantly lower rein tension than competition frame (P < .001) and hyperflexion (P < .001). An association was found between dynamic structural disorders in the upper airway tract evaluated by OGE and head–neck flexion, but this association was not linked to the degree of flexion. The HNP hyperflexion was neither associated with greater rein tension nor severe dynamic structural disorders than the HNP competition frame. This study confirms that low–deep–round is a nonforced position, in contrast to hyperflexion. Further studies are needed to evaluate whether dynamic structural disorders are a result of flexion or if the degree of flexion has an impact.

Electrical stimulation of the whole hypoglossal nerve in patients with obstructive sleep apnea.

Electrical stimulation of the whole hypoglossal nerve (HGp-ES) has been demonstrated to enlarge the pharynx and improve pharyngeal stability and patency to airflow in all animals studied, but not in humans. The present study was undertaken to better understand the effect of HGp-ES on the human pharynx. Eight patients with obstructive sleep apnea who had implanted stimulators with electrodes positioned proximally on the main truck of the hypoglossus were studied under propofol sedation. Pharyngoscopy and air flow measurements at multiple levels of continuous positive airway pressure (CPAP) were performed before and during Hgp-ES. HGp-ES that activates both tongue protrusors and retractors narrowed the pharyngeal lumen at the site of collapse (velopharynx in all subjects) from 1.38 ± 0.79 to 0.75 ± 0.44 cm2, p < 0.05 (measured at mid-range of CPAP levels) and lowered airflow (from 8.88 ± 2.08 to 6.69 ± 3.51 l/min, p < 0.05). Changes in critical pressure (Pcrit) and velopharyngeal compliance were not significant, but oropharyngeal compliance decreased (from 0.43 ± 0.18 to 0.32 ± 0.13 cm2/cmH2O, p < 0.05). No correlation was found between the pattern of change in luminal shape (determined as the ratio of a-p vs. lateral diameter when lowering CPAP) or changes in cross-sectional area and airflow during Hgp-ES. Our findings indicate that human retractors dominate when stimulated together with the protrusors during HGp-ES. While co-activation of retractors may be beneficial, it should be limited. We speculate that exercises that augment protrusor force may improve the response to hypoglossal stimulation. The exclusion of patients with concentric pharyngeal obstruction should be re-evaluated.

Breeding French bulldogs so that they breathe well-Along way to go.

Brachycephalic syndrome (BS) is a pathophysiological disorder caused by excessive soft tissue within the upper airways of short-nosed dog breeds, causing obstruction of the nasal, pharyngeal and laryngeal lumen, resulting in severe respiratory distress. As the prevalence of BS appears to be high among some of the affected breeds, there is an urgent need for breeding efforts to improve the health status of those dogs. In the present study, we evaluated correlations between morphometric and other phenotypic characteristics and BS in a population of 69 French bulldogs from Denmark to identify parameters that could serve as a basis for breeding against BS. Furthermore, the genetic variation was monitored to determine whether it would be possible to breed based on these characteristics without simultaneously causing a critical reduction in genetic variation. Six phenotypic characteristics were correlated with the Brachycephalic Syndrome Functional (BSF) score. Among the morphometric risk factors, nostril stenosis (NS) and neck girth (NG) had the highest impact on the BSF score, accounting for 32% and 4% of the variation, respectively. The genetic variation in the population was comparable to other pure breeds, i.e. estimated and observed heterozygosity was 0.60 and the average inbreeding coefficient was 0.01. If only dogs with Grades 1 and 2 NS (no or only mild NS) were selected for breeding the mean BSF score would be reduced significantly. However, it would result in the exclusion of 81% of the population for breeding and this is not prudent. Excluding only dogs with severe stenosis (Grade 4) would exclude 50% of the population without any adverse impact on genetic variation within the population. Although exclusion of dogs with Grade 4 would result in an apparent reduction in the mean BSF score, this reduction is not significant. As NS accounts for 32% of the variation in BSF score, a possible long term strategy to reduce the prevalence of the BS in French bulldogs would seem to be a selection scheme that first excluded dogs with the most severe NS from breeding, gradually moving towards selecting dogs with lower NS grades. According to our findings there is no viable short term solution for reducing the prevalence of BS in the French bulldog population.

Insights into the feeding behaviors and biomechanics of Varroa destructor mites on honey bee pupae using electropenetrography and histology

Feeding behaviors and biomechanics of female Varroa destructor mites are revealed from AC-DC electropenetrography (EPG) recordings of mites feeding from Apis mellifera honey bee pupae and histology of mite internal ingestion apparatus. EPG signals characteristic of arthropod suction feeding (ingestion) were identified for mites that fed on pupae during overnight recordings. Ingestion by these mites was confirmed afterwards by observing internally fluorescent microbeads previously injected into their hosts. Micrographs of internal ingestion apparatus illustrate the connection between a gnathosomal tube and a pharyngeal lumen, which is surrounded by alternating dilator and constrictor muscles. Inspection of EPG signals showed the muscularized mite pharyngeal pump operates at a mean repetition rate of 4.5 cycles/s to ingest host fluids. Separate feeding events observed for mites numbered between 23 and 33 over approximately 16 h of recording, with each event lasting ~10 s. Feeding events were each separated by ~2 min. Consecutive feeding events separated by either locomotion or prolonged periods of quiescence were grouped into feeding bouts, which ranged in number from one to six. Statistical analyses of EPG data revealed that feeding events were prolonged for mites having lower pharyngeal pump frequencies, and mites having prolonged feeding events went unfed for significantly more time between feeding events. These results suggest that mites may adjust behaviors to meet limitations of their feeding apparatus to acquire similar amounts of food. Data reported here help to provide a more robust view of Varroa mite feeding than those previously reported and are both reminiscent of, as well as distinct from, some other acarines and fluid-feeding insects.

High-Resolution Pharyngeal Manometry and Impedance: Protocols and Metrics-Recommendations of a High-Resolution Pharyngeal Manometry International Working Group.

High-resolution manometry has traditionally been utilized in gastroenterology diagnostic clinical and research applications. Recently, it is also finding new and important applications in speech pathology and laryngology practices. A High-Resolution Pharyngeal Manometry International Working Group was formed as a grass roots effort to establish a consensus on methodology, protocol, and outcome metrics for high-resolution pharyngeal manometry (HRPM) with consideration of impedance as an adjunct modality. The Working Group undertook three tasks (1) survey what experts were currently doing in their clinical and/or research practice; (2) perform a review of the literature underpinning the value of particular HRPM metrics for understanding swallowing physiology and pathophysiology; and (3) establish a core outcomes set of HRPM metrics via a Delphi consensus process. Expert survey results were used to create a recommended HRPM protocol addressing system configuration, catheter insertion, and bolus administration. Ninety two articles were included in the final literature review resulting in categorization of 22 HRPM-impedance metrics into three classes: pharyngeal lumen occlusive pressures, hypopharyngeal intrabolus pressures, and upper esophageal sphincter (UES) function. A stable Delphi consensus was achieved for 8 HRPM-Impedance metrics: pharyngeal contractile integral (CI), velopharyngeal CI, hypopharyngeal CI, hypopharyngeal pressure at nadir impedance, UES integrated relaxation pressure, relaxation time, and maximum admittance. While some important unanswered questions remain, our work represents the first step in standardization of high-resolution pharyngeal manometry acquisition, measurement, and reporting. This could potentially inform future proposals for an HRPM-based classification system specifically for pharyngeal swallowing disorders.

On the median pharyngeal valve of the American alligator (Alligator mississippiensis).

The middle ear cavities of crocodilians have complex connections with the pharyngeal lumen, including lateral and median components which both open into a single chamber located on the dorsal midline of the pharynx. This chamber and the surrounding soft-tissue is herein termed the median pharyngeal valve. In the American alligator (Alligator mississippiensis) this valve opens, for a duration of 0.3 s, approximately every 120 s; the patency of the median pharyngeal valve was not influenced by either auditory stimuli or by submersing the alligator underwater. The median pharyngeal valve has an outer capsule of dense connective tissue and fibrocartilage and an inner "plug" of loose connective tissue. These opposing surfaces are lined by respiratory epithelium and separated by a cavity that is continuous with the middle ear cavities and the pharyngeal lumen (through a central opening in the capsule termed the pore). The inner plug of the median pharyngeal valve is contacted by skeletal muscles positioned to serve as both elevators/retractors (which would open the valve) and elevators/protractors (which, in conjunction with gravity, would close the valve). Unlike other vertebrate valve systems, the median pharyngeal valve appears to function as a deformable ball check valve.

Volumetric Changes to the Pharynx in Healthy Aging: Consequence for Pharyngeal Swallow Mechanics and Function.

Pharyngeal lumen volume is prone to increase as a consequence of pharyngeal muscle atrophy in aging. Yet, the impact of this on swallowing mechanics and function is poorly understood. We examined the relationship between pharyngeal volume and pharyngeal swallowing mechanics and function in a sample of healthy community-dwelling seniors. Data were collected from 44 healthy seniors (21 male, mean age = 76.9, SD = 7.1). Each participant swallowed 9 boluses of barium (3 × 5ml thin, 3 × 20ml thin, 3 × 5ml nectar). Pharyngeal shortening, pharyngeal constriction, pyriform sinus and vallecular residue were quantified from lateral view videofluorosopic swallowing studies. Pharyngeal lumen volume was captured during an oral breathing task with acoustic pharyngometry. In addition, within-participant measures of strength and anthropometrics were collected. Four linear mixed effects regression models were run to study the relationship between pharyngeal volume and pharyngeal constriction, pharyngeal shortening, pyriform sinus residue, and vallecular residue while controlling for bolus condition, age, sex, and posterior tongue strength. Increasing pharyngeal lumen volume was significantly related to worse constriction and vallecular residue. In general, larger and thicker boluses resulted in worse pharyngeal constriction and residue. Pharyngeal shortening was only significantly related to posterior tongue strength. Our work establishes the utility of acoustic pharyngometry to monitor pharyngeal lumen volume. Increasing pharyngeal lumen volume appears to impact both pharyngeal swallowing mechanics and function in a sample of healthy, functional seniors.

A new species of Temnocephala (Platyhelminthes) with an unusual pharynx, including an amendment of the diagnosis of the genus.

Three species of Temnocephala have been reported on Aegla from Uruguay: Temnocephala axenos, Temnocephala mertoni and Temnocephala talicei. As part of a systematic review of the Uruguayan species of Temnocephala, a fourth species was found on Aegla platensis and Aegla uruguayana. This species, new for the genus, has the following diagnostic characters: Large temnocephalan; slightly curved penial stylet (225 µm in length) with a symmetrical introvert (27 long by 18 µm in diameter) that has at least 44 spine-like projections, each bearing 7 rows of internal spines; a seminal vesicle that opens sub-polarly into the contractile vesicle; a muscular vagina with a strong asymmetrical sphincter; preequatorial nephridiopores close to the internal borders of the elongate-oval excretory syncytia; a large pharynx with anterior and posterior sphincters of about the same diameter and a narrow pharyngeal lumen with nearly uniform width. To contemplate the characters of the pharynx, an amendment of the genus Temnocephala is given. The new species resembles Temnocephala cyanoglandula, which also has a very long, slightly curved penial stylet, but differs from it by having a shorter penial stylet, a lower number of rows of spines in the introvert, a larger, different type of pharynx, a smaller contractile vesicle and a larger sucker. The new species is carnivorous and feeds on whole preys, which are mainly annelids (Stratiodrilus) and other species of Temnocephala. The new species was found to be hyperparasitised by plerocercoid and nematode larvae, but hyperparasites were not found in the other sympatric species of Temnocephala. Based on the findings presented here, it is clear that detailed histological descriptions of the pharynx should be contemplated as part of the normal work in taxonomy of temnocephalans.

Relationships between MRI fat distributions and sleep apnea and obesity hypoventilation syndrome in very obese patients

PurposeObesity is associated with both obstructive sleep apnea (OSA) and obesity hypoventilation. Differences in adipose tissue distribution are thought to underlie the development of both OSA and hypoventilation. We explored the relationships between the distribution of upper airway, neck, chest, abdominal and muscle fat in very obese individuals.MethodsWe conducted a cross-sectional cohort study of individuals presenting to a tertiary sleep clinic or for assessment for bariatric surgery. Individuals underwent magnetic resonance (MR) imaging of their upper airway, neck, chest, abdomen and thighs; respiratory polygraphy; 1 week of autotitrating CPAP; and morning arterial blood gas to determine carbon dioxide partial pressure and base excess.ResultsFifty-three individuals were included, with mean age of 51.6 ± 8.4 years and mean BMI of 44.3 ± 7.9 kg/m2; there were 27 males (51%). Soft palate, tongue and lateral wall volumes were significantly associated with the AHI in univariable analyses (p < 0.001). Gender was a significant confounder in these associations. No significant associations were found between MRI measures of adiposity and hypoventilation.ConclusionsIn very obese individuals, our results indicate that increased volumes of upper airway structures are associated with increased severity of OSA, as previously reported in less obese individuals. Increasingly large upper airway structures that reduce pharyngeal lumen size are likely to lead to OSA by increasing the collapsibility of the upper airway. However, we did not show any significant association between regional fat distribution and propensity for hypoventilation, in this population.