Swallowing Time Research Articles

A New Subfascial Approach in Open Thyroidectomy: Efficacy for Postoperative Voice, Sensory, and Swallowing Symptoms. A Randomized Controlled Study

After open thyroidectomy, patients usually complain of voice, sensory, and swallowing symptoms. We approached the thyroid via the subfascial method to reduce these symptoms and compared postthyroidectomy symptoms with the conventional subplatysmal method. Eighty-six patients undergoing thyroidectomy were recruited and randomized into either a conventional subplatysmal approach group (subplatysmal, 42 patients) group or a subanterior fascia of strap muscle approach group (subfascial, 44 patients). Voice symptoms were assessed using the Voice Handicap Index questionnaire and acoustic voice analysis. Sensory alterations were evaluated by the light touch and pain touch methods. Swallowing symptoms were assessed using the Swallowing Impairment Score (SIS) questionnaire, barium swallowing time, and hyoid bone movement range. Each variable was measured preoperatively, and at 2 weeks and 3 months after thyroidectomy. In both groups, the subjective symptoms of voice, sensation, and swallowing were significantly worsened at 2 weeks after operation, but improved 3 months after operation. Patients in the subplatysmal group had worse SIS scores than patients in the subfascial group (p = 0.016) and delayed barium swallowing time 2 weeks after operation (p = 0.008 compared to preoperative level). In the cohort over 50 years of age, SIS score did not recover to preoperative levels in the subplatysmal group 3 months after operation (p = 0.005 compared to preoperative level). The subfascial approach may be an effective method for reducing postthyroidectomy swallowing symptoms based on swallowing impairment score, especially in patients over 50 years of age.

Altered Consistencies of Liquid in the Treatment of Children With Dysphagia

Use of “thinned nectar” consistency, in addition to the standard dysphagia consistencies of nectar-thick, honey-thick, and pudding-thick liquids, has multiple clinical advantages and may contribute to better patient outcomes. At this time, there is no evidence-based research to support these added consistencies; rather, it is a clinical concept offering oral-motor and sensory opportunities using a graded approach while maintaining safety. This concept has been trialed by other experts and was discussed among colleagues during the American Speech Language and Hearing Association (ASHA) annual conference held in November 2011. This article will briefly summarize how the use of altered consistencies may contribute to the following: improve the timing of the pharyngeal swallow through guided practice, reduce the likelihood of prolonged enteral feed requirements, allow infants and children with poor endurance to achieve goal volumes without fatigue, and provide therapist methods for discrete measurement of progress. Anecdotal reports will be used to highlight how this approach may be implemented as a therapy tool during treatment of infants and young children with dysphagia.

Effect of repetitive coughing on swallowing in the anesthetized cat

Aspiration can trigger repetitive coughing, and swallow can be inter‐laced between successive coughs to clear the pharynx of ejected material. We hypothesized that repetitive coughing would increase swallow drive and change swallow phase durations and amplitudes of pharyngeal or laryngeal muscle activities. Cough was induced by mechanical stimulation of the trachea and swallow was elicited by injection of water into the oropharynx in spontaneously breathing cats. Electromyograms (EMG) were recorded from pharyngeal, laryngeal and respiratory muscles. During coughing bouts, EMG amplitudes of the geniohyoid, cricopharyngeus, thyropharyngeus, thyrohyoid significantly increased compared to swallows during eupnea. Swallow‐related phase durations of specific muscles were unchanged during coughing. However, there was a significant reduction in the duration of laryngeal elevation and the total swallow time indicating reduced onset latencies between different upper airway muscle groups. These results support a theory of a highly cooperative airway protective network which responds to aspiration. This network must be present to ensure timely and efficient execution of swallow. Supported by NIH HL89104, HL103415, HL109025.

The swallowing reflex and its significance as an airway defensive reflex

Swallowing function, in humans, is very complex. Swallowing plays, not only an important role in food digestion, but also a major role in preventing the entrance of food and/or other materials into the lower respiratory tract. To achieve this, precise coordination is necessary between breathing and swallowing since the pharynx serves as a common pathway for both respiration and digestion. The swallowing reflex consists of afferent pathways, central integration, and efferent pathways. Any defect or disorder along reflex arc can cause a potential delay or impairment in swallow function. The swallowing reflex can be modulated not only by pathological factors but also by physiological factors. Among these, timing of swallows in relation to the phase of respiration may be the most important factor that determines the occurrence of pulmonary aspiration, since phases of inspiration and the expiration-inspiration transition are the most vulnerable for pulmonary aspiration.

Normalization of Temporal Aspects of Swallowing Physiology after the McNeill Dysphagia Therapy Program

We examined the timing of physiological swallowing events in patients before and after completion of an exercise-based dysphagia intervention (McNeill Dysphagia Therapy Program; MDTP) and compared their performance to that of healthy volunteers. Eight adults (mean age, 57.5 years) with chronic dysphagia (mean, 45 months) completed 3 weeks of the MDTP. Before and after the MDTP we measured lingual-palatal and pharyngeal manometric pressures during swallows of thin liquid, thick liquid, and pudding material in 5-mL volumes. Using the pressure peak of the pharyngoesophageal segment clearing wave as the anchor point, we measured the relative timing of pressure peaks from the anterior, middle, and posterior parts of the tongue and the manometric peaks from the base of the tongue, the hypopharynx, and the nadir of the pharyngoesophageal segment. We compared these results to identical measures obtained from 34 healthy adults (mean age, 44.0 years). The timing of physiological events before the MDTP was significantly slower than that of the group of healthy volunteers. The timing data from after the MDTP were not significantly different from those of the healthy group. The magnitude change was greatest for thin liquid. Dysphagia therapy with the MDTP improves the timing of physiological events during swallowing. Temporal coordination of swallowing components after therapy approximates that of healthy adults, suggesting a normalization of swallow timing after the MDTP.

Prolonged Swallowing Time in Dysphagic Parkinsonism Patients With Aspiration Pneumonia

Lin C-W, Chang Y-C, Chen W-S, Chang K, Chang H-Y, Wang T-G. Prolonged swallowing time in dysphagic Parkinsonism patients with aspiration pneumonia. ObjectiveTo quantitatively measure which dysphagic features, including swallowing time and hyoid bone displacement, would be associated with increased risk of aspiration pneumonia in dysphagic Parkinsonism patients. DesignClinical survey. SettingTertiary care center. ParticipantsPatients with Parkinsonism and dysphagia (N=25), referred for videofluoroscopic swallowing study, were recruited by retrospective review of medical records. They were divided into 2 groups according to the history of aspiration pneumonia. InterventionsNot applicable. Main Outcome MeasureSwallowing time including onset of pharyngeal swallowing, oral transit time and pharyngeal transit time, and maximum hyoid bone displacement including total, horizontal, and vertical displacement during swallowing in thin and thick bariums were recorded. ResultsPatients with history of aspiration pneumonia had significantly longer pharyngeal transit time (4.14 vs 2.31s, P=.038) and onset of pharyngeal swallowing (2.16 vs 1.04s, P=.031) than those without, when swallowing thin barium. Patients with aspiration pneumonia also had significantly longer swallowing time when swallowing thick barium (oral transit time: 7.14 vs 2.33s, P=.018; pharyngeal transit time: 6.39 vs 1.23s, P=.004; onset of pharyngeal swallowing: 5.11 vs .31s, P=.006). There was no significant difference in hyoid bone displacement between the 2 groups. ConclusionsPatients with Parkinsonism dysphagia and aspiration pneumonia had longer swallowing time than those without, but there was no difference in displacement of hyoid bone.

Application of Digital Accelerometry for Swallow Imaging (DASI) for Dysphagia Evaluation and Treatment in a Series of Myotonic Dystrophy Type 1 (DM1) Patients (P05.189)

Objective: To use digital accelerometry for swallow imaging (DASI) for evaluation and treatment of dysphagia in DM1 patients. Background Dysphagia is a potentially life threatening complication of DM1 patients. Design/Methods: Patients with DM1 and history of aspiration or dysphagia underwent a formal swallow evaluation +/- modified barium swallow (MBS). We used noninvasive DASI technology with software designed for swallow imaging and calculation of key parameters of swallow biomechanics. Trials included spontaneous and instructed dry and wet swallows with different consistencies. We analyzed shape, amplitude, timing, frequency and jitter looking for swallow movement dysfunction. DASI biofeedback: Patients observed swallow traces on the computer screen and were coached in improving strength, duration and timing of swallow. Results: Case 1: A 24-year old man with congenital DM1, dysphagia, and repeated hospitalizations for aspiration pneumonia had a MBS showing aspiration of pyriform sinus residue. DASI evaluation showed excessive pre/post-swallow laryngeal movement, decreased pharyngeal phase control with multiple small amplitude peaks. DASI Treatment: Patient improved swallow strenght and control of pharyngeal movement. Case 2: A 46 year-old man with adult-onset DM1 and choking episodes was hospitalized with pneumonia and placed on a ventilator. MBS showed aspiration during/after the swallow with delayed cough. DASI evaluation showed low amplitude and frequency of swallow with increased jitter and frequent coughing. DASI Treatment: Patient improved swallow strength. Case 3: A 33 year-old female with adult-onset DM1 reported dysphagia. Clinical swallow evaluation showed oral residue, reduced hyolaryngeal excursion, and throat clearing. DASI evaluation showed reduced amplitude and increased jitter, with extraneous, inefficient lingual/hyolaryngeal movements. DASI Treatment: Reduced extraneous laryngeal movements and improved control of swallow. Conclusions: DASI is an adjunct in dysphagia evaluation in DM1. DASI biofeedback is helpful in gaining increased swallow function through Active Repetitive Motion Therapy which is instructive for reducing extraneous, inefficient laryngeal movements and can be personalized according to the patient physical and mental status. Supported by: DASI equipment on loan from Elixir Therapeutics. Disclosure: Dr. Farkas has nothing to disclose. Dr. Entrekin has nothing to disclose. Dr. Milstead has nothing to disclose. Dr. Mosman has nothing to disclose. Dr. Berggren has nothing to disclose. Dr. Sampson has received personal compensation for activities with PTC Therapeutics and Myotonic Dystrophy Foundation.

Aspiration and swallowing in Parkinson disease and rehabilitation with EMST

Dysphagia is the main cause of aspiration pneumonia and death in Parkinson disease (PD) with no established restorative behavioral treatment to date. Reduced swallow safety may be related to decreased elevation and excursion of the hyolaryngeal complex. Increased submental muscle force generation has been associated with expiratory muscle strength training (EMST) and subsequent increases in hyolaryngeal complex movement provide a strong rationale for its use as a dysphagia treatment. The current study's objective was to test the treatment outcome of a 4-week device-driven EMST program on swallow safety and define the physiologic mechanisms through measures of swallow timing and hyoid displacement. This was a randomized, blinded, sham-controlled EMST trial performed at an academic center. Sixty participants with PD completed EMST, 4 weeks, 5 days per week, for 20 minutes per day, using a calibrated or sham, handheld device. Measures of swallow function including judgments of swallow safety (penetration-aspiration [PA] scale scores), swallow timing, and hyoid movement were made from videofluoroscopic images. No pretreatment group differences existed. The active treatment (EMST) group demonstrated improved swallow safety compared to the sham group as evidenced by improved PA scores. The EMST group demonstrated improvement of hyolaryngeal function during swallowing, findings not evident for the sham group. EMST may be a restorative treatment for dysphagia in those with PD. The mechanism may be explained by improved hyolaryngeal complex movement. This intervention study provides Class I evidence that swallow safety as defined by PA score improved post EMST.

Inter- and intra-rater reliability in fibroptic endoscopic evaluation of swallowing

Fibroptic endoscopic evaluation of swallowing (FEES) is a useful way for dentists to evaluate oropharyngeal dysfunction. However, no study has paid attention to inter- and intra-rater reliability of FEES evaluation about oropharyngeal dysfunction. The purpose of this study is to verify whether dentist who trained and experienced for evaluation of dysphagia could diagnose oropharyngeal function with FEES. Nine dentists independently evaluated FEES images of 10 cases four times each. At first, evaluators performed the first evaluation without consulting the evaluative criteria. Subsequently, evaluators independently re-evaluated at 1-week intervals for three consecutive weeks, consulting the evaluative criteria. And then, inter- and intra-rater reliability was calculated. Cohen's Kappa was used to assess reliability. The results found that overall inter-rater reliability was 0·35±0·04 (first evaluation), 0·45±0·05 (s), 0·44±0·05 (third) and 0·46±0·04 (fourth). Most of inter-rater reliability related to aspiration was moderate to high, but lower for categories that evaluated timing of swallowing and mastication. In contrast, intra-rater reliability was moderate to high for overall categories, at 0·53±0·04 (first vs. second evaluation), 0·55±0·04 (first vs. third), 0·53±0·04 (first vs. fourth), 0·55±0·03 (second vs. third), 0·60±0·03 (second vs. fourth) and 0·78±0·03 (third vs. fourth). FEES is reliable for experienced dentists to diagnose oropharyngeal function. Moreover, repeated evaluation with the aids of evaluative criteria is useful to improve the reliability of FEES.

Swallow Characteristics in Patients With Oculopharyngeal Muscular Dystrophy

This prospective investigation evaluates oral weakness and its impact on swallow function, weight, and quality of life in patients with oculopharyngeal muscular dystrophy (OPMD). Intraoral pressure, swallow pressure, and endurance were measured using an Iowa Oral Performance Instrument in participants with OPMD and matched controls. Timed water swallow, weight, and quality of life were also assessed. Participants with OPMD were weaker than controls. Oral weakness impacted strength, swallow pressure, swallow capacity, swallow volume, swallow time, and quality of life. Tongue endurance was not affected by oral weakness. This investigation provides further insight into the swallow function of patients with myopathic disease. Muscle fiber loss leads to weakness, which results in reductions in swallow function and quality of life. Weight and endurance are not greatly altered.

The mandible advancement may alter the coordination between breathing and the non-nutritive swallowing reflex

The coordination between nasal breathing and non-nutritive swallowing serves as a protective reflex against potentially asphyxiating material, i.e. saliva and secretions, entering the respiratory tract. Although this protective reflex is influenced by positional changes in the head and body, the effect of mandible position on this reflex is not fully understood. We examined the effect of mandible advancement associated with mouth opening on the coordination between nasal breathing and non-nutritive swallowing induced by continuous infusion of distilled water into the pharyngeal cavity. The combination of mandible advancement and mouth opening increased the duration of swallowing apnoea and submental electromyographic burst duration. When the mandible was advanced with the mouth open, the duration of swallowing apnoea increased significantly compared with the centric position (0.79 +/- 0.23 vs. 0.64 +/- 0.12 s, P < 0.05, n = 12), and the duration of submental electromyographic activity increased significantly (2.11 +/- 0.63 vs. 1.46 +/- 0.25 s, P < 0.05, n = 12). Mandible advancement with mouth opening altered the respiratory phase resetting during swallowing and the timing of swallow in relation to respiratory cycle phase. We conclude that mandible re-positioning may strongly influence the coordination between nasal breathing and non-nutritive swallowing by altering respiratory parameters and by inhibiting movement of the tongue-jaw complex.

ＤＩＰＰ‐Ｍｏｔｉｏｎ Ｐｒｏ ２Ｄを用いた嚥下動態の解析

Cineradiography enables the second stage of swallowing to be analyzed visually in hyoid and laryngeal movements during swallowing, but cost and preparation time have limited its clinical dissemination. To overcome this, we computerized quantitative video fluorographic imaging using commercially available DIPP-Motion Pro 2D® software. This has the advantages of 1) DV images are fed to the computer as animation and analyzed directly; 2) numerous points can be marked and tracked automatically, 3) with coordinate setting and scale correction, movement distance and velocity are measured automatically, and 4) functions synchronizing graphs with cineradiography video facilitate visual understanding. We quantitatively studied swallowing in 6 subjects without dysphagia. Median hyoid bone movement is 10.5 mm on the abscissa and 16.2 mm on the ordinate. Median laryngeal movement is 9.3 mm on the abscissa and 25.1 mm on the ordinate. Maximum bolus is 1011.3 mm/sec. We analyzed swallowing conveniently and effectively, displaying data with visual information. This makes it a handy tool for analyzing swallowing quantitatively in clinical practice. It also enables us to exchange information effectively with other medical personnel and gain informed consent.

Immediate Effects of Thermal–Tactile Stimulation on Timing of Swallow in Idiopathic Parkinson’s Disease

Oropharyngeal dysphagia frequently presents in people with idiopathic Parkinson's disease (IPD). Clinical sequelae of dysphagia in this group include weight loss and aspiration pneumonia, the latter of which is the leading cause of hospital admissions and death in IPD. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. The effects of TTS on swallowing have not yet been investigated in IPD. The aim of this study was to investigate the immediate effects of TTS on the timing of swallow in a cohort of people with IPD and known oropharyngeal dysphagia. Thirteen participants with IPD and known dysphagia attended for videofluoroscopy during which standardised volumes of liquid barium and barium paste were administered preceding and immediately subsequent to TTS. The immediate effects of TTS on swallowing were examined using oral, pharyngeal, and total transit times and pharyngeal delay times as outcome measures. TTS significantly reduced median pharyngeal transit time on fluids (0.20 s, 95% CI = 0.12-0.28, p = 0.004) and on paste (0.3 s, 95% CI = 0.08-0.66, p = 0.01). Median total transit time was also reduced on fluids (0.48 s, 95% CI = 0.00-1.17, p = 0.049) and on paste (0.52 s, 95% CI = 0.08-1.46, p = 0.033). Median pharyngeal delay time was reduced on fluids (0.20 s, 95% CI = 0.12-0.34, p = 0.002). TTS did not significantly alter median oral transit time on either fluid or paste consistency. TTS significantly reduced temporal measures of the pharyngeal phase of swallowing in the IPD population. Significant results may be attributed to the role of sensory stimulation in improving motor function in IPD, with emphasis on the impaired glossopharyngeal and vagus nerves in this population. It is still unclear whether these findings will translate into a clinically beneficial effect.

Effects of Body Positioning on Swallowing and Esophageal Transit in Healthy Dogs

Contrast videofluoroscopy is the imaging technique of choice for evaluating dysphagic dogs. In people, body position alters the outcome of videofluoroscopic assessment of swallowing. That esophageal transit in dogs, as measured by a barium esophagram, is not affected by body position. Healthy dogs (n=15). Interventional, experimental study. A restraint device was built to facilitate imaging of dogs in sternal recumbency. Each dog underwent videofluoroscopy during swallowing of liquid barium and barium-soaked kibble in sternal and lateral recumbency. Timing of swallowing, pharyngeal constriction ratio, esophageal transit time, and number of esophageal peristaltic waves were compared among body positions. Transit time in the cervical esophagus (cm/s) was significantly delayed when dogs were in lateral recumbency for both liquid (2.58+/-1.98 versus 7.23+/-3.11; P=.001) and kibble (4.44+/-2.02 versus 8.92+/-4.80; P=.002). In lateral recumbency, 52+/-22% of liquid and 73+/-23% of kibble swallows stimulated primary esophageal peristalsis. In sternal recumbency, 77+/-24% of liquid (P=.01 versus lateral) and 89+/-16% of kibble (P=.01 versus lateral) swallows stimulated primary esophageal peristalsis. Other variables were not significantly different. Lateral body positioning significantly increases cervical esophageal transit time and affects the type of peristaltic wave generated by a swallow.

Effects of food texture and head posture on oropharyngeal swallowing

This study aimed to describe the electromyographic (EMG) activity patterns of the genioglossus (GG) and suprahyoid (SHy) muscles during swallowing. The effects of changes in food texture/consistency and head posture on transport of the swallowed bolus were also investigated. Participants were 10 normal adults. Test foods consisted of a liquid, a syrup, or 4 ml of paste made from 0.5% or 1.0% agar. Each food was swallowed with the head in one of three positions, and EMGs and videofluorographic (VF) images were recorded. Mean values of onset, peak, and offset times, peak amplitude, area, and duration of the EMG burst were measured. The total swallowing time, oral ejection time, pharyngeal transit time, clearance time, fauces transit time, and upper esophageal sphincter (UES) transit time were measured. The GG muscle burst patterns showed two peaks (GG1 and GG2) during each swallowing. The offset time and duration of the GG1 burst and the onset, peak, and offset times and duration of both the GG2 and SHy bursts were significantly affected by food texture. There were no significant differences in bolus transit time among the different experimental conditions. Regression analyses demonstrated significant linear relationships between the tongue tip touching the palate and the peak of the GG1 burst, between passage of the bolus tail at the fauces and offset of the GG1 burst, between passage of the bolus tail at the UES and peak of the GG2 burst, and between passage of the bolus tail at the UES and offset of the SHy burst. These results demonstrate that the duration, but not the amplitude, of tongue and suprahyoid muscle activity were increased with increasing hardness of food during swallowing and that the bolus transit time can be fixed within a certain range of physical food properties.

Correspondence between food consistency and suprahyoid muscle activity, tongue pressure, and bolus transit times during the oropharyngeal phase of swallowing

This study aimed to evaluate the effects of food texture and viscosity on the swallowing function by measuring tongue pressure and performing a videofluorographic (VF) examination. Eleven normal adults were recruited for this study. Test foods with different consistencies and liquid contents, i.e., a half-solid nutrient made of 0.8 and 1.5% agar powder, syrup, and a liquid containing 40 wt/vol% barium sulfate, were swallowed, and the anterior (AT) and posterior tongue pressures (PT) and electromyographic (EMG) activity of the suprahyoid muscles were recorded, together with VF images. The timing of each event obtained from EMG, tongue pressure, and VF recordings was measured and then compared. We found that the AT and PT activity patterns were similar and showed a single peak. The peak, area, and time duration of all of the variables for AT and PT and EMG burst increased with increasing hardness of the bolus. The onset of the EMG burst always preceded those of the AT and PT activities, while there were no significant differences in peak and offset times among EMG burst, AT, and PT. Total swallowing time and oral ejection time were significantly longer during the swallowing of 1.5% agar than any other boluses, while pharyngeal transit time and clearance time were significantly longer during the swallowing of syrup, which was as hard as the liquid, but showed a higher viscosity than the liquid. The results suggested that the major effects of food hardness were to delay oral ejection time, which strongly delays total swallowing time. In addition, pharyngeal bolus transit is not dependent on the hardness of food but on its viscosity.

Swallowing before and after tonsillectomy as evaluated by surface electromyography

Surface electromyography (sEMG) was performed on adult patients (n = 40) following tonsillectomy to evaluate recovery by objective means. Evaluated parameters included timing of swallowing and continuous drinking, electric amplitude and graphic patterns of masseter (MS), and measurement of infrahyoid (INF) and submental (SUB) muscles after tonsillectomy and comparison with normative database. The duration of drinking periods showed significant increase among patients; single-swallow durations remained normal. The electric activity of MS and INF muscles was significantly higher among the patients compared with normative database. It took one month until all the EMG data returned to normal. Tonsillectomy affects muscle activity during swallowing by involving additional muscles in deglutition. EMG is a simple reliable method for postoperative evaluation and might contribute to comparative analysis of different tonsillectomy techniques. EMG can be used during pre- and postoperative stages to monitor recovery and functional improvement of throat muscles and deglutition. The reported sEMG method and obtained data might be further used: 1) As an additional tool for comparison of different methods of tonsillectomy (eg, cold vs hot dissection, laser surgery, etc); 2) For further development of objective postsurgical pain assessment; 3) As an additional tool for assessment and development of less traumatic surgical technique; and 4) For monitoring of recovery in difficult cases.

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.

Breathing–Swallowing Interaction in Neuromuscular Patients

Malnutrition and aspiration are major problems in patients with neuromuscular disease. Because impaired swallowing contributes to malnutrition, means of improving swallowing are needed. To investigate interactions between breathing and swallowing in neuromuscular disorders and to evaluate the impact of mechanical ventilation (MV) on swallowing in tracheostomized patients. We studied 10 healthy individuals and 29 patients with neuromuscular disease and chronic respiratory failure (including 19 with tracheostomy). The tracheostomized patients who could breathe spontaneously were recorded during spontaneous breathing (SB) and with MV, in random order. Breathing-swallowing interactions were investigated by chin electromyography and inductive respiratory plethysmography, using three water-bolus sizes (5, 10, and 15 ml) in random order. In contrast to healthy individuals, neuromuscular patients showed piecemeal deglutition with several swallows over several breathing cycles for each bolus. The percentage of swallows followed by expiration was about 50% in the patients compared with nearly 100% in the control subjects. The number of swallows and total swallowing time per bolus correlated significantly to maximal inspiratory pressure. In the 10 tracheostomized patients who were recorded both in SB and MV, the number of swallows and total swallowing time per bolus were significantly reduced during MV compared with SB. Neuromuscular patients showed abnormal breathing-swallowing interactions, which correlated to maximal inspiratory pressure. Moreover, MV improved the swallowing parameters in tracheostomized patients who were able to breathe spontaneously.

Evaluation of Swallowing in Children with Gastroesophageal Reflux: PO55

Introduction: Gastroesophageal reflux (GER) is considered to be a cause of infant feeding disorder. Negative experience such as vomiting, regurgitation, dysphagia and painful swallowing may cause aversion or feed refusal, with impairment of the swallowing and feeding processes. Aim: To evaluate the swallowing in children with GER diagnosis. Method: We studied 37 children with GER, mean age 15.4 months and 15 healthy children (HC), mean age 20.5 months. In the videofluoroscopy evaluation a free volume of liquid and 5 ml of paste, mixed with barium were used. Results: Children with GER have more laryngeal penetration (GER 61.8% and HC 33.3% p=0.07) and have more backward compensatory movements of the head (GER 64.7% and HC 0% p 0.05). Conclusion: This study shows that children with GER may present difficulties in feeding although no alteration in the oropharyngeal dynamics timing of swallowing, was found.