title: Manometric evidence for a phonation-induced UES contractile reflex.
abstract: The mechanism against entry of gastric content into the pharynx during high-intensity vocalization such as seen among professional singers is not known. We hypothesized that phonation-induced upper esophageal sphincter (UES) contraction enhances the pressure barrier against entry of gastroesophageal contents into pharynx. To determine and compare the effect of phonation on luminal pressures of the esophagus and its sphincters, we studied 17 healthy volunteers (7 male, 10 female) by concurrent high-resolution manometry and voice analysis. We tested high- and low-pitch vowel sounds. Findings were verified in six subjects by UES manometry using a water-perfused sleeve device. Eight of the volunteers (2 male, 6 female) had concurrent video fluoroscopy with high-resolution manometry and voice recording. Fluoroscopic images were analyzed for laryngeal movement. To define the sex-based effect, subgroup analysis was performed. All tested phonation frequencies and intensities induced a significant increase in UES pressure (UESP) compared with prephonation pressure. The magnitude of the UESP increase was significantly higher than that of the distal esophagus, the lower esophageal sphincter (LES), and the stomach. Concurrent videofluoroscopy did not show posterior laryngeal movement during phonation, eliminating a purely mechanical cause for phonation-induced UESP increase. Subgroup analysis demonstrated phonation-induced UESP increases in males that were significantly greater than those of females. Phonation induces a significant increase in UESP, suggesting the existence of a phonation-induced UES contractile reflex. UESP increase due to this reflex is significantly higher than that of the distal esophagus, LES, and stomach. The phonation-induced UESP increase is influenced by sex.
authors.affiliation: Division of Gastroenterology and Hepatology, Froedtert Hospital/Medical College of Wisconsin Dysphagia Institute, 9200 W Wisconsin Ave., Milwaukee, WI 53226, USA.
authors.forename: Lilani
authors.initials: L
authors.lastname: Perera
authors.forename: Mark
authors.initials: M
authors.lastname: Kern
authors.forename: Candy
authors.initials: C
authors.lastname: Hofmann
authors.forename: Linda
authors.initials: L
authors.lastname: Tatro
authors.forename: Krisna
authors.initials: K
authors.lastname: Chai
authors.forename: Shiko
authors.initials: S
authors.lastname: Kuribayashi
authors.forename: Adeyemi
authors.initials: A
authors.lastname: Lawal
authors.forename: Reza
authors.initials: R
authors.lastname: Shaker
mesh_terms: D000328:Adult; D049631:Esophageal Sphincter, Upper / Q000000981:diagnostic imaging / Q000294:innervation* / Q000502:physiology; D004947:Esophagus / Q000294:innervation / Q000502:physiology; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007823:Laryngeal Nerves / Q000502:physiology; D007830:Larynx / Q000502:physiology; D008297:Male; D008365:Manometry; D009119:Muscle Contraction; D010699:Phonation; D011312:Pressure; D012018:Reflex; D015203:Reproducibility of Results; D012737:Sex Factors; D013018:Sound Spectrography; D013270:Stomach / Q000294:innervation / Q000502:physiology; D014741:Video Recording