title: Definition and implications of novel pharyngo-glottal reflex in human infants using concurrent manometry ultrasonography.
abstract: OBJECTIVE
  Glottal relationships during swallowing dominate the etiology of dysphagia. We investigated the pharyngo-glottal relationships during basal and adaptive swallowing.
  
  
  METHODS
  Temporal changes in glottal closure kinetics (frequency, response latency, and duration) with spontaneous and adaptive pharyngeal swallows were defined in 12 infants using concurrent pharyngoesophageal manometry and ultrasonography of the glottis.
  
  
  RESULTS
  Frequency, response latency, and duration of glottal closure with spontaneous swallows (n=53) were 100%, 0.27+/-0.1 s, and 1+/-0.22 s, respectively. The glottis adducted earlier (P<0.0001 vs. upper esophageal sphincter relaxation) within the same respiratory phase as swallow (P=0.03). With pharyngeal provocations (n=41), glottal adduction (pharyngo-glottal closure reflex (PGCR)) was noted first and then again with pharyngeal reflexive swallow (PRS). The frequency, response latency, and duration of glottal closure with PGCR were 100%, 0.56+/-0.13 s, and 0.52+/-0.1 s, respectively. Response latency to PRS was 3.24+/-0.33 s; the glottis adducted 97% within 0.36+/-0.08 s in the same respiratory phase (P=0.03), and remained adducted for 3.08+/-0.71 s. Glottal adduction was the quickest with spontaneous swallow (P=0.04 vs. PGCR), and the duration was the longest during PRS (P<0.005 vs. PGCR or spontaneous swallow).
  
  
  CONCLUSIONS
  Glottal adduction during basal or adaptive swallowing reflexes occurs in either respiratory phase, thus ensuring airway protection against pre-deglutitive or deglutitive aspiration. The independent existence and magnitude (duration of adduction) of PGCR suggests a hypervigilant state of the glottis in preventing aspiration during swallowing or during high gastroesophageal reflux events. Investigation of pharyngeal-glottal relationships with the use of noninvasive methods may be more acceptable across the age spectrum.
authors: Sections of Neonatology, Pediatric Gastroenterology and Nutrition, Center for Perinatal Research, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, Ohio 43205, USA. jadcherlas@pediatrics.ohio-state.edu
authors: Sudarshan R
authors: SR
authors: Jadcherla
authors: Alankar
authors: A
authors: Gupta
authors: Mansen
authors: M
authors: Wang
authors: Brian D
authors: BD
authors: Coley
authors: Soledad
authors: S
authors: Fernandez
authors: Reza
authors: R
authors: Shaker
mesh_terms: D000222:Adaptation, Physiological; D016009:Chi-Square Distribution; D003679:Deglutition / Q000502:physiology*; D004576:Electromyography; D005260:Female; D005931:Glottis / Q000000981:diagnostic imaging / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008365:Manometry; D010614:Pharynx / Q000000981:diagnostic imaging / Q000502:physiology*; D012018:Reflex / Q000502:physiology*; D012119:Respiration; D013997:Time Factors; D014463:Ultrasonography