TY - JOUR
T1 - Biomechanical Quantification of Mendelsohn Maneuver and Effortful Swallowing on Pharyngo-Esophageal Function.
AU - Doeltgen, Sebastian
AU - Ong, Ellisa
AU - Scholten, Ingrid
AU - Cock, Charles
AU - Omari, Taher
PY - 2017
Y1 - 2017
N2 - Objective: To quantify the effects of 2 swallowing maneuvers used in dysphagia rehabilitation—the Mendelsohn maneuver and effortful swallowing—on pharyngoesophageal function with novel, objective pressure-flow analysis. Study Design: Evaluation of intervention effects in a healthy control cohort. Setting: A pharyngoesophageal motility research laboratory in a tertiary education facility. Subjects: Twelve young healthy subjects (9 women, 28.6 ± 7.9 years) from the general public, without swallowing impairment, volunteered to participate in this study. Methods: Surface electromyography from the floor-of-mouth musculature and high-resolution impedance manometry–based pressure flow analysis were used to assess floor-of-mouth activation and pharyngoesophageal motility, respectively. Subjects each performed 10 noneffortful control swallows, Mendelsohn maneuver swallows, and effortful swallows, with a 5-mL viscous bolus. Repeated measures analyses of variance was used to compare outcome measures across conditions. Results: Effortful and Mendelsohn swallows generated greater floor-of-mouth contraction (P =.001) and pharyngeal pressure (P <.0001) when compared with control swallows. There were no changes at the level of the upper esophageal sphincter, except for a faster opening to maximal diameter during maneuver swallows (P =.01). The proximal esophageal contractile integral was reduced during Mendelsohn swallows (P =.001). Conclusion: Effortful and Mendelsohn maneuver swallows significantly alter the pharyngoesophageal pressure profile. Faster opening of the upper esophageal sphincter may facilitate bolus transfer during maneuver swallows; however, reduced proximal esophageal contractility during Mendelsohn maneuver swallows may impair bolus flow and aggravate dysphagic symptoms.
AB - Objective: To quantify the effects of 2 swallowing maneuvers used in dysphagia rehabilitation—the Mendelsohn maneuver and effortful swallowing—on pharyngoesophageal function with novel, objective pressure-flow analysis. Study Design: Evaluation of intervention effects in a healthy control cohort. Setting: A pharyngoesophageal motility research laboratory in a tertiary education facility. Subjects: Twelve young healthy subjects (9 women, 28.6 ± 7.9 years) from the general public, without swallowing impairment, volunteered to participate in this study. Methods: Surface electromyography from the floor-of-mouth musculature and high-resolution impedance manometry–based pressure flow analysis were used to assess floor-of-mouth activation and pharyngoesophageal motility, respectively. Subjects each performed 10 noneffortful control swallows, Mendelsohn maneuver swallows, and effortful swallows, with a 5-mL viscous bolus. Repeated measures analyses of variance was used to compare outcome measures across conditions. Results: Effortful and Mendelsohn swallows generated greater floor-of-mouth contraction (P =.001) and pharyngeal pressure (P <.0001) when compared with control swallows. There were no changes at the level of the upper esophageal sphincter, except for a faster opening to maximal diameter during maneuver swallows (P =.01). The proximal esophageal contractile integral was reduced during Mendelsohn swallows (P =.001). Conclusion: Effortful and Mendelsohn maneuver swallows significantly alter the pharyngoesophageal pressure profile. Faster opening of the upper esophageal sphincter may facilitate bolus transfer during maneuver swallows; however, reduced proximal esophageal contractility during Mendelsohn maneuver swallows may impair bolus flow and aggravate dysphagic symptoms.
KW - effortful swallowing
KW - high-resolution impedance manometry
KW - impedance
KW - Mendelsohn maneuver
KW - pressure
KW - swallowing
UR - http://www.scopus.com/inward/record.url?scp=85032794847&partnerID=8YFLogxK
U2 - 10.1177/0194599817708173
DO - 10.1177/0194599817708173
M3 - Article
SN - 0194-5998
VL - 157
SP - 816
EP - 823
JO - Otolaryngology-Head and Neck Surgery
JF - Otolaryngology-Head and Neck Surgery
IS - 5
ER -