, Volume 34, Issue 1, pp 129–137 | Cite as

Volumetric Changes to the Pharynx in Healthy Aging: Consequence for Pharyngeal Swallow Mechanics and Function

  • Sonja M. MolfenterEmail author
  • Charles Lenell
  • Cathy L. Lazarus
Original Article


Pharyngeal lumen volume is prone to increase as a consequence of pharyngeal muscle atrophy in aging. Yet, the impact of this on swallowing mechanics and function is poorly understood. We examined the relationship between pharyngeal volume and pharyngeal swallowing mechanics and function in a sample of healthy community-dwelling seniors. Data were collected from 44 healthy seniors (21 male, mean age = 76.9, SD = 7.1). Each participant swallowed 9 boluses of barium (3 × 5 ml thin, 3 × 20 ml thin, 3 × 5 ml nectar). Pharyngeal shortening, pharyngeal constriction, pyriform sinus and vallecular residue were quantified from lateral view videofluorosopic swallowing studies. Pharyngeal lumen volume was captured during an oral breathing task with acoustic pharyngometry. In addition, within-participant measures of strength and anthropometrics were collected. Four linear mixed effects regression models were run to study the relationship between pharyngeal volume and pharyngeal constriction, pharyngeal shortening, pyriform sinus residue, and vallecular residue while controlling for bolus condition, age, sex, and posterior tongue strength. Increasing pharyngeal lumen volume was significantly related to worse constriction and vallecular residue. In general, larger and thicker boluses resulted in worse pharyngeal constriction and residue. Pharyngeal shortening was only significantly related to posterior tongue strength. Our work establishes the utility of acoustic pharyngometry to monitor pharyngeal lumen volume. Increasing pharyngeal lumen volume appears to impact both pharyngeal swallowing mechanics and function in a sample of healthy, functional seniors.


Swallowing Deglutition Dysphagia Deglutition disorders Aging Pharynx Sarcopenia Atrophy Acoustic pharyngometry Pharyngeal constriction Pharyngeal shortening Residue 



The authors would like to thank Erica Herzberg, Danielle Brates, Mehak Noorani, Emily Ottinger, Shelby Norman, Il Young Jung, Julie Bancroft, Wendy Liang, Chelsea Sandler, Marina Casale, and Katrin Gabriel for their assistance during data collection and data analysis and Chuan-Ya Hsu and Ying Lu for statistical consultation.


This study was funded by NIH National Institute on Deafness and Other Communication Disorders 1R21DC015067.

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Ortman JM, Velkoff VA, Hogan H: An aging nation: the older population in the United States. Current population reports, U.S. Census Bureau: 25-1140, 2014.Google Scholar
  2. 2.
    Robbins J. Guest editorial: the current state of clinical geriatric dysphagia research. J Rehabil Res Dev. 2002;4:vii–ix.Google Scholar
  3. 3.
    Chen P, Golub JS, Hapner ER, Johns MM III. Prevalence of perceived dysphagia and quality-of-life impairment in a geriatric population. Dysphagia. 2009;1:1–6.CrossRefGoogle Scholar
  4. 4.
    Roy N, Stemple J, Merrill RM, Thomas L. Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann Otol Rhinol Laryngol. 2007;11:858–65.CrossRefGoogle Scholar
  5. 5.
    Bloem BR, Lagaay AM, van Beek W, Haan J, Roos RA, Wintzen AR. Prevalence of subjective dysphagia in community residents aged over 87. BMJ. 1990;6726:721–2.CrossRefGoogle Scholar
  6. 6.
    Yang EJ, Kim MH, Lim J, Paik N. Oropharyngeal dysphagia in a community-based elderly cohort: The Korean longitudinal study on health and aging. J Korean Med Sci. 2013;10:1534–9.CrossRefGoogle Scholar
  7. 7.
    Kikawada M, Iwamoto T, Takasaki M. Aspiration and infection in the elderly. Drugs Aging. 2005;2:115–30.CrossRefGoogle Scholar
  8. 8.
    Holland G, Jayasekeran V, Pendleton N, Horan M, Jones M, Hamdy S. Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus. 2011;7:476–80.CrossRefGoogle Scholar
  9. 9.
    Altman KW, Yu G, Schaefer SD. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch Otolaryngol Head Neck Surg. 2010;8:784–9.CrossRefGoogle Scholar
  10. 10.
    Robbins J, Gangnon RE, Theis SM, Kays SA, Hewitt AL, Hind JA. The effects of lingual exercise on swallowing in older adults. J Am Geriatr Soc. 2005;9:1483–9.CrossRefGoogle Scholar
  11. 11.
    Nagai H, Russell JA, Jackson MA, Connor NP. Effect of aging on tongue protrusion forces in rats. Dysphagia. 2008;2:116–21.CrossRefGoogle Scholar
  12. 12.
    Ota F, Connor NP, Konopacki R. Alterations in contractile properties of tongue muscles in old rats. Annal Otol Rhinol Laryngol. 2005;10:799–803.CrossRefGoogle Scholar
  13. 13.
    Butler SG, Stuart A, Leng X, Wilhelm E, Rees C, Williamson J, Kritchevsky SB. The relationship of aspiration status with tongue and handgrip strength in healthy older adults. J Gerontol Ser A Biol Sci Med Sci. 2011;4:452–8.CrossRefGoogle Scholar
  14. 14.
    Feng X, Todd T, Lintzenich CR, Ding J, Carr JJ, Ge Y, Browne JD, Kritchevsky SB, Butler SG. Aging-related geniohyoid muscle atrophy is related to aspiration status in healthy older adults. J Gerontol Ser A Biol Sci Med Sci. 2013;7:853–60.CrossRefGoogle Scholar
  15. 15.
    Leonard R, Kendall KA, McKenzie S. Structural displacements affecting pharyngeal constriction in nondysphagic elderly and nonelderly adults. Dysphagia. 2004;2:133–41.Google Scholar
  16. 16.
    Kendall KA, Leonard RJ. Pharyngeal constriction in elderly dysphagic patients compared with young and elderly nondysphagic controls. Dysphagia. 2001;4:272–8.CrossRefGoogle Scholar
  17. 17.
    Aminpour S, Leonard R, Fuller SC, Belafsky PC. Pharyngeal wall differences between normal younger and older adults. ENT. 2011;4:1–4.Google Scholar
  18. 18.
    Molfenter SM, Amin M, Branski RC, Brumm J, Hagiwara M, Roof S, Lazarus CL. Age-related changes in pharyngeal lumen size: a retrospective MRI analysis. Dysphagia. 2015;3:321–7.CrossRefGoogle Scholar
  19. 19.
    Inamoto Y, Saitoh E, Okada S, Kagaya H, Shibata S, Baba M, Onogi K, Hashimoto S, Katada K, Wattanapan P. Anatomy of the larynx and pharynx: effects of age, gender and height revealed by multidetector computed tomography. J Oral Rehabil. 2015;9:670–7.CrossRefGoogle Scholar
  20. 20.
    Dejaeger E, Pelemans W, Ponette E, Joosten E. Mechanisms involved in postdeglutition retention in the elderly. Dysphagia. 1997;2:63–7.CrossRefGoogle Scholar
  21. 21.
    Frederick MG, Ott DJ, Grishaw EK, Gelfand DW, Chen MYM. Functional abnormalities of the pharynx: a prospective analysis of radiographic abnormalities relative to age and symptoms. Am J Roentgenol. 1996;2:353–7.CrossRefGoogle Scholar
  22. 22.
    Rofes L, Arreola V, Romea M, Palomera E, Almirall J, Cabré M, Serra-Prat M, Clavé P. Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol Motil. 2010;8:851-858+e230.Google Scholar
  23. 23.
    Kamal I. Test-retest validity of acoustic pharyngometry measurements. Otolaryngol Head Neck Surg. 2004;2:223–8.CrossRefGoogle Scholar
  24. 24.
    Brooks LJ, Byard PJ, Fouke JM, Strohl KP. Reproducibility of measurements of upper airway area by acoustic reflection. J Appl Physiol. 1989;6:2901–5.CrossRefGoogle Scholar
  25. 25.
    Marshall I, Maran NJ, Martin S, Jan MA, Rimmington JE, Best JJK, Drummond GB, Douglas NJ. Acoustic reflectometry for airway measurements in man: implementation and validation. Physiol Meas. 1993;2:157–69.CrossRefGoogle Scholar
  26. 26.
    Hoffstein V, Fredberg JJ. The acoustic reflection technique for non-invasive assessment of upper airway area. Eur Respir J. 1991;5:602–11.Google Scholar
  27. 27.
    Fredberg JJ, Wohl MEB, Glass GM, Dorkin HL. Airway area by acoustic reflections measured at the mouth. J Appl Physiol Respir Environ Exerc Physiol. 1980;5:749–58.Google Scholar
  28. 28.
    Bradley TD, Brown IG, Grossman RF, Zamel N, Martinez D, Phillipson EA, Hoffstein V. Pharyngeal size in snorers, nonsnorers, and patients with obstructive sleep apnea. N Engl J Med. 1986;21:1327–31.CrossRefGoogle Scholar
  29. 29.
    Viviano JS. Acoustic reflection: review and clinical applications for sleep-disordered breathing. Sleep Breath. 2002;3:129–49.CrossRefGoogle Scholar
  30. 30.
    D’Urzo AD, Rubinstein I, Lawson VG, Vassal KP, Rebuck AS, Slutsky AS, Hoffstein V. Comparison of glottic areas measured by acoustic reflections vs. computerized tomography. J Appl Physiol. 1988;1:367–70.CrossRefGoogle Scholar
  31. 31.
    Molfenter SM. The reliability of oral and pharyngeal dimensions captured with acoustic pharyngometry. Dysphagia. 2016;4:555–9.CrossRefGoogle Scholar
  32. 32.
    Nicosia MA, Hind JA, Roecker EB, Carnes M, Doyle J, Dengel GA, Robbins J. Age effects on the temporal evolution of isometric and swallowing pressure. J Gerontol A Biol Sci Med Sci. 2000;11:M634–40.CrossRefGoogle Scholar
  33. 33.
    Youmans SR, Youmans GL, Stierwalt JA. Differences in tongue strength across age and gender: is there a diminished strength reserve? Dysphagia. 2009;1:57–65.CrossRefGoogle Scholar
  34. 34.
    Stierwalt JA, Youmans SR. Tongue measures in individuals with normal and impaired swallowing. Am J Speech Lang Pathol. 2007;2:148–56.CrossRefGoogle Scholar
  35. 35.
    Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ. Validity and reliability of the eating assessment tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;12:919–24.CrossRefGoogle Scholar
  36. 36.
    DePippo KL, Holas MA, Reding MJ. Validation of the 3-oz water swallow test for aspiration following stroke. Arch Neurol. 1992;12:1259–61.CrossRefGoogle Scholar
  37. 37.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;3:M146–56.CrossRefGoogle Scholar
  38. 38.
    Vorperian HK: VTLab Acoustic Pharyngometry (APh) Protocol: Data collection (Part I) & data analysis (Part II) 09/09, 2013.Google Scholar
  39. 39.
    D’Urzo AD, Lawson VG, Vassal KP, Rebuck AS, Slutsky AS, Hoffstein V. Airway area by acoustic response measurements and computerized tomography. Am Rev Respir Dis. 1987;2:392–5.Google Scholar
  40. 40.
    Fink TA, Ross JB. Are we testing a true thin liquid? Dysphagia. 2009;3:285–9.CrossRefGoogle Scholar
  41. 41.
    Molfenter SM, Steele CM. Variation in temporal measures of swallowing: sex and volume effects. Dysphagia. 2013;2:226–33.CrossRefGoogle Scholar
  42. 42.
    Schneider CA, Rasband WS, Eliceiri KW. NIH Image to ImageJ: 25 years of image analysis. Nat Methods. 2012;7:671.CrossRefGoogle Scholar
  43. 43.
    Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;2:93–8.CrossRefGoogle Scholar
  44. 44.
    Stokely SL, Peladeau-Pigeon M, Leigh C, Molfenter SM, Steele CM. The relationship between pharyngeal constriction and post-swallow residue. Dysphagia. 2015;30:349–56.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Leonard R, Rees CJ, Belafsky P, Allen J. Fluoroscopic surrogate for pharyngeal strength: the pharyngeal constriction ratio (PCR). Dysphagia. 2011;1:13–7.CrossRefGoogle Scholar
  46. 46.
    Olsson R, Castell J, Johnston B, Ekberg O, Castell DO. Combined videomanometric identification of abnormalities related to pharyngeal retention. Acad Radiol. 1997;5:349–54.CrossRefGoogle Scholar
  47. 47.
    Kahrilas PJ, Logemann JA, Lin S, Ergun GA. Pharyngeal clearance during swallowing: a combined manometric and videofluoroscopic study. Gastroenterology. 1992;1:128–36.CrossRefGoogle Scholar
  48. 48.
    Molfenter SM, Hsu CY, Lu Y, Lazarus CL. Alterations to swallowing physiology as the result of effortful swallowing in healthy seniors. Dysphagia. 2018;33:380–8.CrossRefPubMedGoogle Scholar
  49. 49.
    Pearson WG Jr, Molfenter SM, Smith ZM, Steele CM. Image-based measurement of post-swallow residue: the normalized residue ratio scale. Dysphagia. 2013;2:167–77.CrossRefGoogle Scholar
  50. 50.
    Fleiss JL. The design and analysis of clinical experiments. New York: Wiley; 1986.Google Scholar
  51. 51.
    Allen JE, White CJ, Leonard RJ, Belafsky PC. Prevalence of penetration and aspiration on videofluoroscopy in normal individuals without dysphagia. Dysphagia. 2010;4:347–8.Google Scholar
  52. 52.
    Daggett A, Logemann J, Rademaker A, Pauloski B. Laryngeal penetration during deglutition in normal subjects of various ages. Dysphagia. 2006;4:270–4.Google Scholar
  53. 53.
    Sporns PB, Muhle P, Hanning U, Suntrup-Krueger S, Schwindt W, Eversmann J, Warnecke T, Wirth R, Zimmer S, Dziewas R. Atrophy of swallowing muscles is associated with severity of dysphagia and age in patients with acute stroke. J Am Med Dir Assoc. 2017;18(7):635-e1.CrossRefGoogle Scholar
  54. 54.
    Nativ-Zeltzer N, Logemann JA, Zecker SG, Kahrilas PJ. Pressure topography metrics for high-resolution pharyngeal-esophageal manofluorography-a normative study of younger and older adults. Neurogastroenterol Motil. 2016;5:721–31.CrossRefGoogle Scholar
  55. 55.
    Stokely S, Molfenter SM, Leigh C, Peladeau-Pigeon M, Steele CM. The relationship between pharyngeal constriction and post-swallow residue. Abstract, Dysphagia Research Society Meeting. Dysphagia. 2014;6:737.Google Scholar
  56. 56.
    Molfenter SM, Steele CM. Use of an anatomical scalar to control for sex-based size differences in measures of hyoid excursion during swallowing. J Speech Lang Hear Res. 2014;3:768–78.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Communicative Sciences & DisordersNYU SteinhardtNew YorkUSA
  2. 2.Department of Otolaryngology Head & Neck Surgery, Mount Sinai Beth IsraelTHANC FoundationNew YorkUSA
  3. 3.Department of Otolaryngology Head & Neck SurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA

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