Pharyngeal pressure generation during tonguehold maneuver

PURPOSE: Fujiu et al. (1996) and Lazarus et al. (2002)provided data toward the effects of a tonguehold maneuver on biomechanical measures of swallowing in healthy and dysphagic research participants, respectively. This study investigates pharyngeal manometric pressure measures during the tonguehold maneuver in young healthy volunteers. METHODS: 20 healthy participants, gender equally represented, completed 5 counterbalanced noneffortful and tonguehold saliva swallows. A pharyngeal catheter (Medical Measurements Inc.; Model CT/S3 + emg, 2.1 mm indiameter) containing 3 manometric sensors was positionedwith the top most sensor at the level of base-of-tongue(BOT) to posterior pharyngeal wall (PPW) approximation, sensor 2 at the level of the laryngeal additus and sensor 3 in the high pressure zone of the upper esophageal sphincter(UES). Manometric peak and temporal measures were collected off-line for analysis. RESULTS: Tonguehold swallows created significantly lower pressures in the upper pharynx than noneffortful saliva swallows (p = .001). Further, males produced relatively greater pressure than females during noneffortful saliva swallows (p = .002). No significant differences intemporal measures were observed. CONCLUSION: While the tonguehold maneuver is designed to strengthen posterior pharyngeal constrictor musculature, the current study provides evidence that increased anterior bulge of the PPW, as reported in other studies (Fujiu, et al., 1995; Fujiu & Logemann, 1996) does not compensate for decreased pressure generation at the level of the upper pharynx. This may impede bolus flow through the pharynx and therefore confirms the precautions stated by Fujiu that this technique is limited to a rehabilitative muscle strengthening exercise.