Adult Swallows Research Articles

Variability of Swallow-associated Sounds in Adults and Infants

We previously used cervical auscultation (CA) to describe the stability of swallow-associated sounds of infant feeding. To date, no similar studies have been performed in adults. The objectives of this study were to identify the initial discrete sounds (IDS) of adult swallows and compare the stability of IDS signals in infants to that of adults. We performed CA with a microphone and accelerometer fixed simultaneously to the neck of 20 healthy adults. Each participant consumed a liquid, puree, and solid. The microphone and accelerometer collected signals of similar duration. The variance index (VI), an assessment of the stability of the IDS, was compared in adults and a group of low-risk preterm infants. The VI of adults swallowing liquid (29.1 [24.1, 36.6] {25%, 75%}) did not differ from that of preterm infants older than 36 weeks PMA (36.3 [33.4, 41.9]), but was lower than the VI of infants younger than 36 weeks PMA (49.0 [46.4, 51.1]; p < 0.05). This is the first real-time comparison of microphones and accelerometers for CA. The stability of IDS of low-risk preterm infants approaches that of normal adults as the infants age. Because successful feeding in infants is often used as a surrogate for normal development, the stability of swallow-associated sounds deserves more investigation as a potential marker for neurologic well-being.

Development of the movement of the epiglottis in infant and juvenile pigs

Although backward folding of the epiglottis is one of the signal events of the mammalian adult swallow, the epiglottis does not fold during the infant swallow. How this functional change occurs is unknown, but we hypothesize that a change in swallow mechanism occurs with maturation, prior to weaning. Using videofluoroscopy, we found three characteristic patterns of swallowing movement at different ages in the pig: an infant swallow, a transitional swallow and a post-weaning (juvenile or adult) swallow. In animals of all ages, the dorsal region of the epiglottis and larynx was held in an intranarial position by a muscular sphincter formed by the palatopharyngeal arch. In the infant swallow, increasing pressure in the oropharynx forced a liquid bolus through the piriform recesses on either side of a relatively stationary epiglottis into the esophagus. As the infant matured, the palatopharyngeal arch and the soft palate elevated at the beginning of the swallow, so exposing a larger area of the epiglottis to bolus pressure. In transitional swallows, the epiglottis was tilted backward relatively slowly by a combination of bolus pressure and squeezing of the epiglottis by closure of the palatopharyngeal sphincter. The bolus, however, traveled alongside but never over the tip of the epiglottis. In the juvenile swallow, the bolus always passed over the tip of the epiglottis. The tilting of the epiglottis resulted from several factors, including the action of the palatopharyngeal sphincter, higher bolus pressure exerted on the epiglottis and the allometry of increased size. In both transitional and juvenile swallows, the subsequent relaxation of the palatopharyngeal sphincter released the epiglottis, which sprang back to its original intranarial position.

Delayed Initiation of the Pharyngeal Swallow: Normal Variability in Adult Swallows

The purpose of this investigation was to determine bolus head timing and location relations with the onset of hyoid movement at the initiation of the pharyngeal swallow and at the onset of swallow-related apnea. Bolus head timing and location and the timing of swallow-related apnea were recorded from frame-by-frame analyses of 5-ml single liquid swallows using dual-modality videofluoroscopy and nasal airflow recordings in 82 consecutive, healthy volunteers. The presence, depth, and response to airway entry were also recorded and related to the bolus head location and the onset of hyoid movement. The majority of participants-80% on at least 1 trial-produced the onset of hyoid movement at pharyngeal swallow initiation after the bolus head passed the posterior angle of the mandible. There was a trend in older participants for later onset of hyoid movement and onset of apnea relative to bolus head arrival at the posterior angle of the mandible. Although entry of the bolus head into the pharynx prior to hyoid movement may result in a threat to the laryngeal airway, these data demonstrate that a "delay" by itself cannot be assumed to indicate a disordered swallow without coexisting impairments of swallowing physiology.

Coordinative Organization of Lingual Propulsion during the Normal Adult Swallow

Lingual propulsion during swallowing is characterized by the sequential elevation of the anterior, middle, and dorsal regions of the tongue. Although lingual discoordination underlies many swallowing disorders, the coordinative organization of lingual propulsion during the typical and disordered swallow is poorly understood. The purpose of this investigation was to quantitatively describe the coordinative organization of lingual propulsion during the normal adult swallow. Tongue movement data were obtained from the X-Ray Microbeam Database at the University of Wisconsin. Movement of four pellets placed on specific tongue regions were tracked in 36 healthy adult participants while they swallowed 10 cc of water across five discrete trials. The propulsive action of the tongue during bolus transport was quantified using a cross-correlation analysis. Lingual transit time (LTT), which was defined as the interval (lag time) between the movements of the anterior- and posterior-most tongue regions, was determined to be approximately 168 ms. The average time interval (lag) between the movements of the posterior tongue regions was significantly shorter than the intervals between more anterior tongue regions. The results also suggest that during bolus transport movement patterns of the anterior tongue regions are distinct from those of the posterior tongue regions. Future work is needed to determine if the absence of the observed coordinative organization of lingual propulsion is indicative of oral stage dysphagia.

Feather mites are positively associated with daily survival in cliff swallows

Feather mites (Acari: Astigmata) have been reported to be parasitic, commensal, and even mutualistic on the birds that serve as their hosts. We investigated whether there was a relationship between number of feather mites ( Pteronyssoides obscurus (Berlese, 1885)) on the wing and daily survival of cliff swallows ( Petrochelidon pyrrhonota (Vieillot, 1817)) during the breeding season at 12 nesting colonies in Nebraska in 2005. Survival of birds with known mite loads was monitored by mark–recapture, and survival models with and without a linear effect of mites were compared with the program MARK. For adult swallows, mites were positively associated with daily survival at six colonies, negatively associated at two colonies, and there was no relationship at four colonies. For recently fledged juveniles studied at two colonies, survival varied positively with mite load at one, while the other showed no relationship. Feather mites may provide direct benefits to cliff swallows by consuming old oil, pollen, fungi, and harmful bacteria on the feathers or by pre-empting resources used by deleterious fungi or bacteria. The data do not support a truly parasitic relationship in which mites are costly to cliff swallows; these particular feather mites may be beneficial mutualists.

Cerebral cortical processing of swallowing in older adults

While brain-imaging studies in young adults have implicated multiple cortical regions in swallowing, investigations in older subjects are lacking. This study examined the neural representations of voluntary saliva swallowing and water swallowing in older adults. Nine healthy females were examined with event-related functional magnetic resonance imaging (fMRI) while laryngeal swallow-related movements were recorded. Swallowing in the older adults, like young adults, activated multiple cortical regions, most prominently the lateral pericentral, perisylvian, and anterior cingulate cortex. Activation of the postcentral gyrus was lateralized to the left hemisphere for saliva and water swallowing, consistent with our findings in young female subjects. Comparison of saliva and water swallowing revealed a fourfold increase in the brain volume activated by the water swallow compared to the saliva swallow, particularly within the right premotor and prefrontal cortex. This task-specific activation pattern may represent a compensatory response to the demands of the water swallow in the face of age-related diminution of oral sensorimotor function.

The effect of surface electrical stimulation on hyolaryngeal movement in normal individuals at rest and during swallowing

Surface electrical stimulation is currently used in therapy for swallowing problems, although little is known about its physiological effects on neck muscles or swallowing. Previously, when one surface electrode placement was used in dysphagic patients at rest, it lowered the hyolaryngeal complex. Here we examined the effects of nine other placements in normal volunteers to determine 1) whether movements induced by surface stimulation using other placements differ, and 2) whether lowering the hyolaryngeal complex by surface electrical stimulation interfered with swallowing in healthy adults. Ten bipolar surface electrode placements overlying the submental and laryngeal regions were tested. Maximum tolerated stimulation levels were applied at rest while participants held their mouths closed. Videofluoroscopic recordings were used to measure hyoid bone and subglottic air column (laryngeal) movements from resting position and while swallowing 5 ml of liquid barium, with and without stimulation. Videofluoroscopic recordings of swallows were rated blind to condition using the National Institutes of Health-Swallowing Safety Scale. Significant (P < 0.0001) laryngeal and hyoid descent occurred with stimulation at rest. During swallowing, significant (P <or= 0.01) reductions in both the larynx and hyoid bone peak elevation occurred during stimulated swallows. The stimulated swallows were also judged less safe than nonstimulated swallows using the National Institutes of Health-Swallowing Safety Scale (P = 0.0275). Because surface electrical stimulation reduced hyolaryngeal elevation during swallowing in normal volunteers, our findings suggest that surface electrical stimulation will reduce elevation during swallowing therapy for dysphagia.

The Effects of Lingual Exercise on Swallowing in Older Adults

To determine the effects of an 8-week progressive lingual resistance exercise program on swallowing in older individuals, the most "at risk" group for dysphagia. Prospective cohort intervention study. Subjects were recruited from the community at large. Ten healthy men and women aged 70 to 89. Each subject performed an 8-week lingual resistance exercise program consisting of compressing an air-filled bulb between the tongue and hard palate. At baseline and Week 8, each subject completed a videofluoroscopic swallowing evaluation for kinematic and bolus flow assessment of swallowing. Swallowing pressures and isometric pressures were collected at baseline and Weeks 2, 4, and 6. Four of the subjects also underwent oral magnetic resonance imaging (MRI) to measure lingual volume. All subjects significantly increased their isometric and swallowing pressures. All subjects who had the MRI demonstrated increased lingual volume of an average of 5.1%. The findings indicate that lingual resistance exercise is promising not only for preventing dysphagia due to sarcopenia, but also as a treatment strategy for patients with lingual weakness and swallowing disability due to frailty or other age-related conditions. The potential effect of lingual exercise on reducing dysphagia-related comorbidities (pneumonia, malnutrition, and dehydration) and healthcare costs while improving quality of life is encouraging.

Assessment of intraluminal impedance for the detection of pharyngeal bolus flow during swallowing in healthy adults

Intraluminal impedance, a nonradiological method for assessing bolus flow within the gut, may be suitable for investigating pharyngeal disorders. This study evaluated an impedance technique for the detection of pharyngeal bolus flow during swallowing. Patterns of pharyngoesophageal pressure and impedance were simultaneously recorded with videofluoroscopy in 10 healthy volunteers during swallowing of liquid, semisolid, and solid boluses. The timing of bolus head and tail passage recorded by fluoroscopy was correlated with the timing of impedance drop and recovery at each recording site. Bolus swallowing produced a drop in impedance from baseline followed by a recovery to at least 50% of baseline. The timing of the pharyngeal and esophageal impedance drop correlated with the timing of the arrival of the bolus head. In the pharynx, the timing of impedance recovery was delayed relative to the timing of clearance of the bolus tail. In contrast, in the upper esophageal sphincter (UES) and proximal esophagus, the timing of impedance recovery correlated well with the timing of clearance of the bolus tail. Impedance-based estimates of pharyngoesophageal bolus clearance time correlated with true pharyngoesophageal bolus clearance time. Patterns of intraluminal impedance recorded in the pharynx during bolus swallowing are therefore more complex than those in the esophagus. During swallowing, mucosal contact between the tongue base and posterior pharyngeal wall prolongs the duration of pharyngeal impedance drop, leading to overestimation of bolus tail timing. Therefore, we conclude that intraluminal impedance measurement does not accurately reflect the bolus transit in the pharynx but does accurately reflect bolus transit across the UES and below.

Residues of Toxaphene in Insectivorous Birds (Petrochelidon spp.) From the Rio Grande, Texas

Although it has been documented that wildlife in the Rio Grande Valley (RGV) contain increased concentrations of organochlorine (OC) contaminants, particularly DDE, little has been published on residues of toxaphene throughout this major North American watershed. In this study, 28 liver composites from adult swallows (Petrochelidon spp.) collected along the Rio Grande from 1999 through 2000 were analyzed for toxaphene residues using congener-specific gas chromatography-electron-capture negative ionization-mass spectrometry. Estimated total toxaphene concentrations ranged from 12 to 260 ng/g wet wt and were highest in samples from the lower RGV near Llano Grande Lake in Hidalgo and Cameron counties (Texas). Toxaphene congener profiles were relatively invariant throughout the watershed and were dominated by 2,2,5-endo,6-exo,8,8,9,10-octachlorobornane (P-42a or B8-806) with lesser amounts of several other Cl(7)-Cl(9) compounds, many of which remain unidentified. Petrochelidon spp. liver profiles appear to be intermediate in complexity between those in invertebrates and fish (more complex) and mammals (less complex) and differs somewhat from those reported for other avian species. In addition to other legacy OC contaminants, toxaphene residues were most concentrated in the lower RGV and accumulated at up to hundreds of parts per billion in these insect-eating birds, underscoring their utility as avian bioindicators of persistent organic pollutants.

Respiration and Swallowing in Healthy Adults and Infants

Respiration and Swallowing in Healthy Adults and Infants

Fiberoptic Examination of Swallowing in Children and Young Adults With Severe Developmental Disability

Fiberoptic Examination of Swallowing in Children and Young Adults With Severe Developmental Disability

Cortical representation of swallowing in normal adults: functional implications.

Dysphagia of neurogenic or postsurgical origin presents management and therapeutic challenges to the otolaryngologist. Improvements in management and therapeutic approaches may be facilitated by understanding how the central nervous system controls swallowing. The purpose of this investigation was to utilize functional magnetic resonance imaging to determine patterns of cortical activity during swallowing in normal, healthy adult subjects. Functional magnetic resonance imaging (fMRI) was performed on eight healthy adult subjects using conventional BOLD (blood oxygenation level dependent) techniques. Subjects performed three different swallowing tasks including dry and bolus swallows, and performed a control finger movement task. Statistical maps of cortical activation were generated using a cross-correlation analysis. One-way and two-way ANOVA statistical analyses were performed to compare activated areas among the different tasks and to determine the effects of task sequence. Activation during the three swallowing tasks occurred in the primary motor cortex, primary somatosensory cortex, and other cortical and subcortical sites. Cortical representation of swallowing and finger movement followed somatotopic maps. Differential distribution of cortical activation was observed for the different swallowing tasks. Activation of the primary motor and somatosensory cortices, as well as other sensory-motor areas, occurs with swallowing in normal adults. Differential distribution of cortical activity with different swallowing tasks suggests differential functional organization for different swallowing tasks. Understanding these mechanisms may facilitate improved management and therapeutic intervention for neurogenic and postsurgical dysphagia.

Fitness Components Associated with Clutch Size in Cliff Swallows

We report measures of annual reproductive success and survival probabilities of adult and offspring Cliff Swallows (Petrochelidon pyrrhonota) associated with clutches of different sizes in southwestern Nebraska from 1982 to 1997. Clutch size 4 was the most com- mon (47.6% of nests). Mean clutch size varied among years, mostly through differences in the proportions of clutch sizes 3 and 4. Temperature and rainfall during egg laying were unrelated to mean annual clutch size. Incubation period declined slightly with clutch size, suggesting no incubation costs associated with larger clutches. Fledging success increased with clutch size. Ectoparasites lowered fledging success significantly in clutch sizes 3 and 4 but not in smaller or larger clutch sizes. First-year survival probability was unaffected by clutch or brood size when ectoparasites were removed, but under natural conditions survival probabilities varied among years and differed significantly among birds reared in brood siz- es 1 to 2, 3 to 4, and 5. Birds tending clutch size 4 produced the highest number of young recruited as breeders in four of eight years; in the remaining years, birds tending clutch size 5 apparently did best. Fitness associated with clutch size 5 varied significantly with tem- perature during brood rearing, being lowest in warm years. Averaged over all years, the highest fitness was conferred at clutch size 5. Parental survival did not differ among clutch or brood sizes for birds under natural levels of ectoparasitism. Body mass of nestlings at 10 days did not vary among clutch sizes in nonfumigated nests and was significantly higher for nestlings in fumigated nests only for the intermediate clutch sizes (2 to 4). Classical life- history tradeoffs probably cannot account for the observed distribution of clutch sizes in Cliff Swallows. Climate and ectoparasite load vary enough annually and are unpredictable enough that Cliff Swallows apparently pursue the risk-averse strategy of laying smaller clutches on average than they can sometimes raise. Ectoparasitism accounted for much of the risk associated with producing clutch size 5, but Cliff Swallows did not adjust their clutch sizes in response to levels of ectoparasitism. Clutch size in aerial insectivores such as swal- lows may also reflect energetic constraints associated with egg production early in the breed- ing season when food is often reduced by cold weather. Received 12 January 1998, accepted 21

Cholinesterase inhibition in tree swallows (Tachycineta bicolor) and eastern bluebirds (Sialia sialis) exposed to organophosphorus insecticides in apple orchards in Ontario, Canada

Apple orchards occupy approximately 12,565 ha of land in Ontario, Canada, and are treated with the greatest number and applications of pesticides among all agricultural crops within the province. The potential for exposure to wildlife from frequent organophosphorus (OP) spray applications is therefore considerable. This study investigated the impact of agricultural spray ap- plications of azinphos-methyl, diazinon, phosalone, and phosmet in apple orchards on the cholinesterase (ChE) activity of wild birds nesting in orchards. These four OP pesticides ranked among the most widely used insecticides used on all fruit crops in Ontario in 1988. Tree swallows ( Tachycineta bicolor) and eastern bluebirds (Sialia sialis) were chosen as monitor species because they commonly breed and forage within apple orchards, utilize different feeding strategies, and are readily attracted to nest boxes. Brain and plasma ChE activities were determined for nestling bluebirds and swallows, and plasma ChE was measured in adult swallows for comparison with nestling data. In adult tree swallows, mean plasma ChE levels were significantly inhibited 41% compared to controls 12 h after a second application of azinphos-methyl. Mean plasma ChE activity in another group of adult tree swallows dropped by 21 and 19% following a multiple phosmet application. In nestlings, brain ChE activities obtained postspray often fell below predicted activities calculated from control siblings. This trend was especially apparent in the younger nestlings, less than 6 d old. However, for bluebirds the rates of increase of brain ChE with age in nestlings from treated sites was significantly lower than in nestlings from control sites. Brain ChE activity of two nestlings found dead following a phosalone application gave no indication that insecticide exposure was responsible. No other dead or moribund birds were discovered during the course of the study. Sequential plasma sampling of siblings, before and after OP application, was beneficial in reducing the required number of nests sampled by one half, but plasma ChE was less reliable overall than brain ChE in indicating exposure. Results of depressed ChE levels in tree swallows and eastern bluebirds inhabiting apple orchards are consistent with avian species in other orchard monitoring studies. No indication was found that OP exposure due to agricultural spraying in apple orchards adversely affected the survival of the birds we monitored.

ANATOMY AND PHYSIOLOGY OF SWALLOWING IN ADULTS AND GERIATRICS

Key anatomic and physiologic features that play an important role in normal and abnormal swallowing in the adult are described. Highlighted topics include the neurologic afferent and efferent control mechanisms, the effect of stroke on these mechanisms, and the upper and lower esophageal sphincters.

Esophago/Pharyngo/Laryngeal Interrelationships: Airway protection mechanisms

This presentation is part of a parallel seminar entitled "Esophago/Pharyngo/Laryngeal Interrelationships." It reports on some of the work done to elucidate the intricate mechanisms involved in transporting food/liquid through the pharynx while simultaneously protecting the airway from aspiration. Significant species differences occur during swallowing, which influence the interpretation of experimental results. Briefly discussed in this panel presentation are the distinction between the glottic closure reflex and laryngospasm; some variations that occur in normal and disordered adult swallowing; the sequence of events during swallowing; differences in the reciprocal relationship between breathing and swallowing in adults as contrasted with infants; and laryngeal reflexes engendered by esophageal stimulation.

Reproductive success of barn swallows nesting near a selenium-contaminated lake in east Texas, USA

Reproductive success and contaminant levels in 1986 and 1987 were compared between Barn Swallows nesting at selenium-contaminated Martin Lake, Texas, USA, and swallows nesting at a reference site. Nests were initiated about the same time or earlier at Martin Lake than at the reference site and clutch size was similar between the two locations. Nest success was significantly higher at Martin Lake than at the reference site and no embryo or chick deformities were documented. Selenium concentrations in 14 of 20 eggs from Martin Lake were above background (> 3 ppm, dry weight); two of 20 eggs contained > 5 ppm, a concentration associated with a 20% embryo mortality/deformity rate in some bird species. Selenium concentrations in the kidneys of adult swallows were higher at Martin Lake (mean = 14 ppm dry weight) than at the reference site (5·8 ppm). DDE, the only detected organochlorine compound, was in two of 10 eggs from Martin Lake; these concentrations were below those associated with chronic poisoning and reproductive problems. The maximum mercury concentration in livers of adult Barn Swallows (0·83 ppm, dry weight) was within the range for background levels (>5 ppm).

Oropharyngeal swallowing in normal adults of different ages

In an effort to evaluate the effect of normal aging on oropharyngeal events of swallowing, 80 normal volunteers, stratified by gender into four age groups, were studied. Liquid and semisolid swallows were performed and recorded simultaneously using videofluoroscopy and manometry. Several parameters, including total duration of oropharyngeal swallowing, were significantly longer in the oldest age group than in any other age group. A delay in initiation of maximal hyolaryngeal excursion primarily accounted for the longer durations with increased age. Significant durational changes also were found as a function of bolus consistency and presence or absence of the manometry tube. Females had a longer duration of upper esophageal sphincter (UES) opening. The amplitude of pharyngeal pressures, duration of peak pharyngeal pressures, and rate of propagation of the contractions were not significantly different for age, gender, or consistency of bolus. No significant differences were found between age groups or between genders in UES pressure. Normal aging affects some parameters of swallowing, while others are preserved.

The preening activity of swallows, Hirundo rustica, in relation to experimentally manipulated loads of haematophagous mites

Whether differences in preening activity among breeding swallows might be a reliable predictor of infection rates by the haematophagous mite Ornithonyssus bursa was tested by recording preening during an experimental manipulation of mite population density. Mite populations of newly built nests were either decreased by spraying with a pesticide, or increased by inoculation with ca 50 mites, while other nests were kept as controls. Adult swallows did not alter their preening rates in relation to experimental treatment despite the fact that the experimental treatments strongly affected mite densities. Nestlings raised in nests inoculated with mites preened much more than did control nestlings, which preened more than did nestlings from sprayed nests. Individual swallows had consistent preening rates throughout the breeding season. Male swallows preened more than females, and male preening activity was strongly positively correlated with that of their mates. Swallows preening much during their first clutches maintained a high preening frequency during their second clutch, although there was a general seasonal decrease in preening rates. Swallows rearing two broods preened more than did pairs rearing only a single brood.