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Tu1452 Dynamics of Pharyngeal Contraction During Vocalization, Cough and Swallowing Maneuvers Using High Resolution Manometry
Tu1451 Correlative Patterns of Upper Esophageal Sphincter Contractility to Skeletal and Smooth Muscle Esophageal Segments: Implications for Neuromuscular Control Megan K. Lutz, Benson T. Massey, Mark Kern, Reza Shaker, Arash Babaei
UES: upper esophageal sphincter
Background: Efferent control of motor activity in the striated and smooth muscle esophageal segments in man reside in separate brainstem nuclei. These different functional units are readily identifiable on high resolution manometry (HRM). Motor responses within the smooth muscle segment are known to be highly variable and dependent upon parameters such as bolus volume. It is unknown whether motor function in the striated muscle segment responds identically to different afferent inputs. Spontaneous "dry" swallows provide a platform to study motor variability that is not artificially constrained by prescribed bolus volumes and times of deglutition. Aim: 1) Define the variability and correlation of pressure phenomena during deglutitive UES after-contraction and proximal esophageal contractions and 2) determine concordance of contractile activity in the striated and smooth segments. Methods: Esophageal HRM of 10 young healthy subjects were studied. Temporally isolated dry swallows without interference of bolus transport, and other swallows were chosen for analysis. We analyzed UES and esophageal pressure parameters using smart mouse tool in color contour plots. Esophageal contractile wave segments above and below the transitional zone were identified. Both temporal and amplitude characteristics of UES after-contraction and segmental esophageal contractile pressure waves were recorded. Linear regression analysis was used to determine correlation of pressure parameters. Results: The manometric length of UES, esophageal proximal striated muscle and distal smooth muscle segments were 3 + 0.5, 4 + 1 cm and 13 + 3 cm respectively. There was significant intra- and inter-subject variability in contractile parameters in the two striated muscle segments. During the first phase of UES postdeglutitive after-contraction pressure dropped down expeditiously from its peak contraction while during the second phase, UES tone declined back to baseline slowly. Duration and vigor of the first phase of UES post-deglutitive contraction significantly correlated with duration and contraction amplitude of proximal striated esophagus. This correlation did not exist with esophageal smooth muscle segment. Conclusion: Despite considerable variability in contractile activity from swallow-to-swallow, the motor activity in upper esophageal sphincter and proximal esophageal striated muscle segment is congruous, consistent with a shared locus of control. The lack of correlation between contractility of the esophageal striated and smooth muscle segments is consistent with being served by two different control centers that are not tightly linked in their response to afferent stimuli.
*-P<0.001 Tu1453 Pharyngeal Bolus Transit in a Human Model of Restricted Swallowing; A Multi-Channel Intraluminal Impedance Study Ling Mei, Gokulakrishnan Balasubramanian, Rachael Manderle, Mark Kern, Patrick Sanvanson, Hongmei Jiao, Reza Shaker Impedance changes during swallow have been proposed to reflect the bolus kinematics as a surrogate. Using this technique, our Aim was to determine and characterize the pharyngeal bolus kinematics/transit in a human model of Restricted Swallowing (RS). Methods: We studied 10 heathy volunteers (6 males, 49 ± 26 years). To induce restricted swallowing, we used a handmade device. This device is comprised of an inflatable concave cushion (13.5x9.5cm) that molds over the larynx and a Velcro strap that could be comfortably worn around the neck holding the device in place and in full contact with the larynx. Inflation of the cushion, results in cupping of the convexity of the larynx inducing resistance to the anterior and superior excursion of the hyo-laryngeal complex during swallowing. Magnitude of the restriction to laryngeal excursions and swallowing is controlled by the pressures applied to inflate the molding cushion. Using this technique, we studied the effect of 0 and 40mmHg restricting pressure on the pharyngeal bolus transit during swallowing of 5 and 10ml half-normal saline in upright position. Pharyngeal and UES impedance changes were recorded by four and two impedance couplets, respectively. Bolus transit time was measured as the time between the 50% drop (representing head of the bolus) in impedance of the most proximal couplets to 50% recovery (representing tail of the bolus) in impedance of the most distal couplets in the pharynx. UES transit time was measured by similar approach. Results: In the pharynx, the bolus transit time for both 5 and 10ml volumes were significantly shorter in the restricted swallows compared to non-restricted swallows, p<0.05 (table). Within the segment of UES, there was no statistical difference in bolus transit time between restricted and non-restricted swallows. Bolus volume did not affect the transit time in either pharynx or the UES significantly. Conclusions: The proposed human model of restricted swallowing significantly affects the kinematics of the swallowed bolus in the pharynx as evidenced by reduction in the bolus transit time. This effect is absent in the UES. This model has the potential to help in better understanding of the pathophysiology of a number of clinical conditions associated with abnormal laryngeal excursions and pharyngeal shortening such as those observed after radiation therapy and stroke. Supported in part by R01DK025731 and P01DK068051. Pharyngeal and UES bolus transit time
Tu1452 Dynamics of Pharyngeal Contraction During Vocalization, Cough and Swallowing Maneuvers Using High Resolution Manometry Gokulakrishnan Balasubramanian, Mark Kern, Rachael Manderle, Ling Mei, Patrick Sanvanson, Arash Babaei, Reza Shaker Introduction: Pharynx is anatomically a complex organ comprised of several muscle groups with different neural control mechanisms. This anatomical complexity mirrors the functional complexity of the pharynx being essential for deglutition, phonation and several respiratory functions such as coughing and breathing. Despite the availability of electromyographic and radiologic data, manometric data on contribution of different muscle component of the pharynx to the above mentioned functions remains scarce The reason for this scarcity has been the lack of a reliable recording device with acceptable sensitivity and specificity for measuring a wide range of pressures with different rise rates from the entire length of the pharynx during various function. With advent of HRM these shortcomings are remedied. The Aim of the present study therefore was to characterize and compare the pharyngeal pressure phenomena during swallowing, coughing and vocalization. Methods: We studied 9 healthy volunteers (mean age: 51± 25Y, 4F) using a high resolution manometry catheter with 36 sensor spaced 1 cm apart positioned such that it spanned the entire pharyngeal contractile zone, upper esophageal sphincter (UES) and proximal esophagus. We studied each of the followingsX3: vocalization maneuvers (AAA, OOO, EEE and KKK) for ten seconds cough and near dry swallow (0.5ml). We evaluated the pressure waves at each site in the
*p<0.05 RS: Restricted Swallow by 40mmHg pressure No RS: Without restricting pressure
S-895
AGA Abstracts
AGA Abstracts
pharynx and used e-sleeve for evaluation of UES during each of the above mentioned tasks. Statistical analysis was done using repeated measure ANOVA adjusted for multiple comparisons by Bonferroni method. Results: Vocalization maneuvers caused increased pharyngeal pressures in the most distal sensors from UES. Pharyngeal contraction was initiated in the distal sensors from UES while proximal sensors from UES showed pharyngeal pressurization during vocalization maneuvers like AAA, OOO, EEE, and KKK while there was simultaneous contraction of UES and pharynx overlying the distal sensors from UES during cough. Peak pharyngeal pressures in the distal channels from UES are comparable during each of the vocalization maneuvers while KKK maneuver produced higher peak pharyngeal pressures in the proximal sensors from UES when compared with peak pharyngeal pressures during other vocalization maneuvers (AAA, OOO, and EEE). Increase in baseline UES pressure during cough was significantly higher than those during vocalization maneuvers (P=0.03). Conclusion: Pharyngeal pressure wave and UES contraction were significantly different during deglutition compared to vocalization and coughing maneuvers. Pharyngeal muscles involved in vocalization maneuvers may not be the same as that of deglutition. Supported in part by R01DK025731 and P01DK068051. Table 1: Change in UES Pressure during vocalization and cough
UES: upper esophageal sphincter
Background: Efferent control of motor activity in the striated and smooth muscle esophageal segments in man reside in separate brainstem nuclei. These different functional units are readily identifiable on high resolution manometry (HRM). Motor responses within the smooth muscle segment are known to be highly variable and dependent upon parameters such as bolus volume. It is unknown whether motor function in the striated muscle segment responds identically to different afferent inputs. Spontaneous "dry" swallows provide a platform to study motor variability that is not artificially constrained by prescribed bolus volumes and times of deglutition. Aim: 1) Define the variability and correlation of pressure phenomena during deglutitive UES after-contraction and proximal esophageal contractions and 2) determine concordance of contractile activity in the striated and smooth segments. Methods: Esophageal HRM of 10 young healthy subjects were studied. Temporally isolated dry swallows without interference of bolus transport, and other swallows were chosen for analysis. We analyzed UES and esophageal pressure parameters using smart mouse tool in color contour plots. Esophageal contractile wave segments above and below the transitional zone were identified. Both temporal and amplitude characteristics of UES after-contraction and segmental esophageal contractile pressure waves were recorded. Linear regression analysis was used to determine correlation of pressure parameters. Results: The manometric length of UES, esophageal proximal striated muscle and distal smooth muscle segments were 3 + 0.5, 4 + 1 cm and 13 + 3 cm respectively. There was significant intra- and inter-subject variability in contractile parameters in the two striated muscle segments. During the first phase of UES postdeglutitive after-contraction pressure dropped down expeditiously from its peak contraction while during the second phase, UES tone declined back to baseline slowly. Duration and vigor of the first phase of UES post-deglutitive contraction significantly correlated with duration and contraction amplitude of proximal striated esophagus. This correlation did not exist with esophageal smooth muscle segment. Conclusion: Despite considerable variability in contractile activity from swallow-to-swallow, the motor activity in upper esophageal sphincter and proximal esophageal striated muscle segment is congruous, consistent with a shared locus of control. The lack of correlation between contractility of the esophageal striated and smooth muscle segments is consistent with being served by two different control centers that are not tightly linked in their response to afferent stimuli.
*-P<0.001 Tu1453 Pharyngeal Bolus Transit in a Human Model of Restricted Swallowing; A Multi-Channel Intraluminal Impedance Study Ling Mei, Gokulakrishnan Balasubramanian, Rachael Manderle, Mark Kern, Patrick Sanvanson, Hongmei Jiao, Reza Shaker Impedance changes during swallow have been proposed to reflect the bolus kinematics as a surrogate. Using this technique, our Aim was to determine and characterize the pharyngeal bolus kinematics/transit in a human model of Restricted Swallowing (RS). Methods: We studied 10 heathy volunteers (6 males, 49 ± 26 years). To induce restricted swallowing, we used a handmade device. This device is comprised of an inflatable concave cushion (13.5x9.5cm) that molds over the larynx and a Velcro strap that could be comfortably worn around the neck holding the device in place and in full contact with the larynx. Inflation of the cushion, results in cupping of the convexity of the larynx inducing resistance to the anterior and superior excursion of the hyo-laryngeal complex during swallowing. Magnitude of the restriction to laryngeal excursions and swallowing is controlled by the pressures applied to inflate the molding cushion. Using this technique, we studied the effect of 0 and 40mmHg restricting pressure on the pharyngeal bolus transit during swallowing of 5 and 10ml half-normal saline in upright position. Pharyngeal and UES impedance changes were recorded by four and two impedance couplets, respectively. Bolus transit time was measured as the time between the 50% drop (representing head of the bolus) in impedance of the most proximal couplets to 50% recovery (representing tail of the bolus) in impedance of the most distal couplets in the pharynx. UES transit time was measured by similar approach. Results: In the pharynx, the bolus transit time for both 5 and 10ml volumes were significantly shorter in the restricted swallows compared to non-restricted swallows, p<0.05 (table). Within the segment of UES, there was no statistical difference in bolus transit time between restricted and non-restricted swallows. Bolus volume did not affect the transit time in either pharynx or the UES significantly. Conclusions: The proposed human model of restricted swallowing significantly affects the kinematics of the swallowed bolus in the pharynx as evidenced by reduction in the bolus transit time. This effect is absent in the UES. This model has the potential to help in better understanding of the pathophysiology of a number of clinical conditions associated with abnormal laryngeal excursions and pharyngeal shortening such as those observed after radiation therapy and stroke. Supported in part by R01DK025731 and P01DK068051. Pharyngeal and UES bolus transit time
Tu1452 Dynamics of Pharyngeal Contraction During Vocalization, Cough and Swallowing Maneuvers Using High Resolution Manometry Gokulakrishnan Balasubramanian, Mark Kern, Rachael Manderle, Ling Mei, Patrick Sanvanson, Arash Babaei, Reza Shaker Introduction: Pharynx is anatomically a complex organ comprised of several muscle groups with different neural control mechanisms. This anatomical complexity mirrors the functional complexity of the pharynx being essential for deglutition, phonation and several respiratory functions such as coughing and breathing. Despite the availability of electromyographic and radiologic data, manometric data on contribution of different muscle component of the pharynx to the above mentioned functions remains scarce The reason for this scarcity has been the lack of a reliable recording device with acceptable sensitivity and specificity for measuring a wide range of pressures with different rise rates from the entire length of the pharynx during various function. With advent of HRM these shortcomings are remedied. The Aim of the present study therefore was to characterize and compare the pharyngeal pressure phenomena during swallowing, coughing and vocalization. Methods: We studied 9 healthy volunteers (mean age: 51± 25Y, 4F) using a high resolution manometry catheter with 36 sensor spaced 1 cm apart positioned such that it spanned the entire pharyngeal contractile zone, upper esophageal sphincter (UES) and proximal esophagus. We studied each of the followingsX3: vocalization maneuvers (AAA, OOO, EEE and KKK) for ten seconds cough and near dry swallow (0.5ml). We evaluated the pressure waves at each site in the
*p<0.05 RS: Restricted Swallow by 40mmHg pressure No RS: Without restricting pressure
S-895
AGA Abstracts
AGA Abstracts
pharynx and used e-sleeve for evaluation of UES during each of the above mentioned tasks. Statistical analysis was done using repeated measure ANOVA adjusted for multiple comparisons by Bonferroni method. Results: Vocalization maneuvers caused increased pharyngeal pressures in the most distal sensors from UES. Pharyngeal contraction was initiated in the distal sensors from UES while proximal sensors from UES showed pharyngeal pressurization during vocalization maneuvers like AAA, OOO, EEE, and KKK while there was simultaneous contraction of UES and pharynx overlying the distal sensors from UES during cough. Peak pharyngeal pressures in the distal channels from UES are comparable during each of the vocalization maneuvers while KKK maneuver produced higher peak pharyngeal pressures in the proximal sensors from UES when compared with peak pharyngeal pressures during other vocalization maneuvers (AAA, OOO, and EEE). Increase in baseline UES pressure during cough was significantly higher than those during vocalization maneuvers (P=0.03). Conclusion: Pharyngeal pressure wave and UES contraction were significantly different during deglutition compared to vocalization and coughing maneuvers. Pharyngeal muscles involved in vocalization maneuvers may not be the same as that of deglutition. Supported in part by R01DK025731 and P01DK068051. Table 1: Change in UES Pressure during vocalization and cough