Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Experimental Section

Pharyngoglottal Closure Reflex: Characterization in Healthy Young, Elderly and Dysphagic Patients with Predeglutitive Aspiration

Shaker R. · Ren J. · Bardan E. · Easterling C. · Dua K. · Xie P. · Kern M.

Author affiliations

MCW Dysphagia Institute, Division of Gastroenterology and Hepatology, Departments of Medicine, and Otolaryngology and Communication Sciences, Digestive Disease Center, Medical College of Wisconsin, and Zablocki VA Medical Center, Milwaukee, Wisc., USA

Related Articles for ""

Gerontology 2003;49:12–20

Do you have an account?

Login Information





Contact Information












By signing up for MyKarger you will automatically participate in our year-End raffle.
If you Then Do Not wish To participate, please uncheck the following box.

Yes, I wish To participate In the year-End raffle And Get the chance To win some Of our most interesting books, And other attractive prizes.


I have read the Karger Terms and Conditions and agree.



Login Information





Contact Information












By signing up for MyKarger you will automatically participate in our year-End raffle.
If you Then Do Not wish To participate, please uncheck the following box.

Yes, I wish To participate In the year-End raffle And Get the chance To win some Of our most interesting books, And other attractive prizes.


I have read the Karger Terms and Conditions and agree.



To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.


Save over 20% compared to the individual article price.
Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply

Rental: USD 8.50
Cloud: USD 20.00


Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Experimental Section

Received: August 02, 2001
Accepted: February 23, 2002
Published online: December 16, 2002
Issue release date: January – February

Number of Print Pages: 9
Number of Figures: 6
Number of Tables: 0

ISSN: 0304-324X (Print)
eISSN: 1423-0003 (Online)

For additional information: https://www.karger.com/GER

Abstract

Background: Mechanism(s) of aspiration, a common complication of oropharyngeal dysphagia, is not completely elucidated. Since the pharyngoglottal closure reflex induces vocal cord adduction in healthy young humans, it may help prevent aspiration during premature spill of oral content. Objective: The objective of this study was to characterize this reflex in normal young and elderly humans and dysphagic patients with predeglutitive aspiration; a potential group for developing abnormalities of this reflex. Methods: We used a concurrent video endoscopic and manometric technique for recording of the vocal cords’ response to pharyngeal water stimulation. We first studied 9 young (26 ± 2 years) and 9 elderly (77 ± 14 years) healthy volunteers to characterize and determine the effect of aging on the pharyngoglottal closure reflex. Subsequently, we studied 8 patients (65 ± 16 years) with predeglutitive aspiration and 7 age-matched controls to characterize this reflex among patients with compromised airway safety during swallowing. Results: The threshold volume of water for triggering both glottal closure and reflexive pharyngeal swallow in the elderly volunteers for rapid pulse injection was significantly larger than that for the young (p < 0.05). Neither glottal closure reflex nor pharyngeal reflexive swallow could be induced in any of the dysphagic patients with volumes of injected water as large as 1 ml. In contrast, in all age-matched controls, both the pharyngoglottal reflex and reflexive pharyngeal swallow were stimulated with threshold volumes of 0.3 ± 0.07 and 0.6 ± 0.05 ml, respectively. Conclusions: Pharyngeal stimulation by water induces vocal cord adduction in humans; the pharyngoglottal closure reflex. Although preserved, a significantly larger volume of water is required to stimulate this reflex by rapid pulse injection in the elderly, suggesting some deterioration in this age group. The pharyngoglottal closure reflex induced by rapid pulse injection is absent in dysphagic patients with predeglutitive aspiration, suggesting its contribution to airway protection against aspiration.

© 2003 S. Karger AG, Basel


References

  1. Ren J, Shaker R, Dua K, Trifan A, Podvrsan B, Sui Z: Glottal adduction response to pharyngeal water stimulation: Evidence for a pharyngoglottal closure reflex. Gastroenterology 1994;106:A558.
  2. Shaker R, Medda BK, Ren J, Jaradeh S, Xie P, Lang IM: Pharyngoglottal closure reflex: Identification and characterization in a feline model. Am J Physiol 1998;275:G521–G525.
  3. Dua KS, Ren J, Bardan E, Xie P, Shaker R: Coordination of deglutitive glottal function and pharyngeal bolus transit during normal eating. Gastroenterology 1997;112:78–83.
  4. Shaker R, Ren J, Zamir Z, Sarna A, Liu J, Sui Z: Effect of aging, position, and temperature on the threshold volume triggering pharyngeal swallows. Gastroenterology 1994;107:396–402.
  5. Ren J, Xie P, Lang IM, Bardan E, Sui Z, Shaker R: Deterioration of the pharyngo-UES contractile reflex in the elderly. Laryngoscope 2000;110:1563–1566.
  6. Shaker R, Ren J, Xie P, Lang IM, Bardan E, Sui Z: Characterization of the pharyngo-UES contractile reflex in humans. Am J Physiol 1997;273:G854–G858.
  7. Shaker R, Dodds WJ, Dantas RO, Hogan WJ, Arndorfer RC: Coordination of deglutitive glottic closure with oropharyngeal swallowing. Gastroenterology 1990;98:1478–1487.
  8. Shaker R, Dodd WJ, Ren J, Hogan WJ, Arndorfer RC: Esophagoglottal closure reflex: A mechanism of airway protection. Gastroenterology 1992;102:857–861.
  9. Sasaki CT, Isaacson G: Functional anatomy of the larynx. Otolaryngol Clin North Am 1988;21:595–612.
  10. Woodson GE: Upper airway anatomy and function; in Byron J, Baily JB (eds): Head and Neck Surgery – Otolaryngology. Philadelphia, Lippincott, 1993, vol 1, pp 492–500.
  11. Nishino T: Swallowing as a protective reflex for the upper respiratory tract. Anesthesiology 1993;79:588–601.
  12. Pommerenke W: A study of the sensory areas eliciting the swallowing reflex. Am J Physiol 1928;84:36–41.
  13. Mittal RK, Chiareli C, Liu J, Shaker R: Characteristics of lower esophageal sphincter relaxation induced by pharyngeal stimulation with minute amounts of water. Gastroenterology 1996;111:378–384.
  14. Trifan A, Ren J, Arndorfer R, Hofmann C, Bardan E, Shaker R: Inhibition of progressing primary esophageal peristalsis by pharyngeal water stimulation in humans. Gastroenterology 1996;110:419–423.
  15. Xie P, Ren J, Bardan E, Mittal RK, Sui Z, Shaker R: Frequency of gastroesophageal reflux events induced by pharyngeal water stimulation in young and elderly subjects. Am J Physiol 1997;272:G233–G237.
  16. Bardan E, Xie P, Ren J, Dua K, Shaker R: Effect of pharyngeal water stimulation on esophageal peristalsis and bolus transport. Am J Physiol 1997;272:G265–G271.
  17. Trifan A, Shaker R, Ren J, Mittal RK, Saeian K, Dua K, Kusano M: Inhibition of resting lower esophageal sphincter pressure by pharyngeal water stimulation in humans. Gastroenterology 1995;108:441–446.
  18. Shaker R, Ulualp SO, Kannappan A, Narayanan S, Hofmann C: Identification of laryngo-UES contractile reflex in humans. Gastroenterology 1999;116:A1081.
  19. Ulualp SO, Kannappan A, Narayanan S, Hofmann C, Arndorfer RC, Shaker R: Topography of the aerodigestive tract sensory field mediating lower esophageal sphincter relaxation: A preliminary report. Gastroenterology 1999;116:A1095.
  20. Aviv JE, Martin JH, Jones ME, Wee TA, Diamond B, Keen MS, Blitzer A: Age-related changes pharyngeal and supraglottic sensation. Ann Otol Rhinol Laryngol 1994;103:749–752.
  21. Shaker R, Ren J, Kern M, Dodds WJ, Hogan WJ, Li Q: Mechanisms of airway protection and UES opening during belching. Am J Physiol 1992;262:G621–G628.
  22. Aviv JE, Sacco RL, Mohr JP, Thompson JLP, Levin B, Sunshine S, Thomson J, Close LG: Laryngopharyngeal sensory testing with modified barium swallow as predictors of aspiration pneumonia after stroke. Laryngoscope 1997;107:1254–1260.
  23. Kidd D, Lawson J, Macmahon J: Aspiration in acute stroke: A clinical study with videofluoroscopy. Q J Med 1993;86:825–829.

Article / Publication Details

First-Page Preview
Abstract of Experimental Section

Received: August 02, 2001
Accepted: February 23, 2002
Published online: December 16, 2002
Issue release date: January – February

Number of Print Pages: 9
Number of Figures: 6
Number of Tables: 0

ISSN: 0304-324X (Print)
eISSN: 1423-0003 (Online)

For additional information: https://www.karger.com/GER


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.