title: The effect of voluntary pharyngeal swallowing maneuvers on esophageal swallowing physiology.
abstract: The purpose of our study was to evaluate whether swallowing maneuvers designed to impact pharyngeal physiology would also impact esophageal physiology. Healthy volunteers underwent high-resolution manometry while performing three randomized swallowing maneuvers with and without a 5-ml bolus: normal swallowing, Mendelsohn maneuver, and effortful swallowing. We examined esophageal parameters of peristaltic swallows, hypotensive or failed swallows ("nonperistaltic swallows"), distal contractile integral (DCI), contractile front velocity (CFV), intrabolus pressure, and transition zone (TZ) defect. Four females and six males (median age 39 years; range 25-53) were included in the study. The overall number of nonperistaltic swallows was 21/40 (53 %) during normal swallowing, 27/40 (66 %) during the Mendelsohn maneuver, and 13/40 (33 %) during effortful swallowing. There were significantly more overall nonperistaltic swallows with the Mendelsohn maneuver compared with effortful swallowing (p = 0.003). While swallowing a 5-ml bolus, there were more nonperistaltic swallows during the Mendelsohn maneuver (12/20, 60 %) compared to that during normal swallowing (6/20, 30 %) (p = 0.05) and more peristaltic swallows during effortful swallowing as compared to Mendelsohn maneuver (p = 0.003). Intrabolus esophageal pressure was greater during the Mendelsohn maneuver swallows in the bolus-swallowing condition as compared to normal swallowing (p = 0.02). There was no statistical difference in DCI, CFV, or TZ defect between swallowing conditions. The Mendelsohn maneuver may result in decreased esophageal peristalsis while effortful swallowing may improve esophageal peristalsis. Because it is important to understand the implications for the entire swallowing mechanism when considering retraining techniques for our patients, further investigation is warranted.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, 135 Rutledge Avenue, Suite 1130, Charleston, SC, 29425, USA, aorourke@musc.edu.
authors.forename: Ashli
authors.initials: A
authors.lastname: O'Rourke
authors.forename: Lori B
authors.initials: LB
authors.lastname: Morgan
authors.forename: Enrique
authors.initials: E
authors.lastname: Coss-Adame
authors.forename: Michele
authors.initials: M
authors.lastname: Morrison
authors.forename: Paul
authors.initials: P
authors.lastname: Weinberger
authors.forename: Gregory
authors.initials: G
authors.lastname: Postma
mesh_terms: D000328:Adult; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000503:physiopathology; D049631:Esophageal Sphincter, Upper / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D010528:Peristalsis / Q000502:physiology; D010614:Pharynx / Q000502:physiology*; D011312:Pressure; D011446:Prospective Studies