Volumetric Changes to the Pharynx in Healthy Aging: Consequence for Pharyngeal Swallow Mechanics and Function
- 921 Downloads
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.
KeywordsSwallowing 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
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 was obtained from all individual participants included in the study.
- 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.Robbins J. Guest editorial: the current state of clinical geriatric dysphagia research. J Rehabil Res Dev. 2002;4:vii–ix.Google Scholar
- 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
- 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
- 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
- 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.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
- 38.Vorperian HK: VTLab Acoustic Pharyngometry (APh) Protocol: Data collection (Part I) & data analysis (Part II) 09/09, 2013.Google Scholar
- 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
- 50.Fleiss JL. The design and analysis of clinical experiments. New York: Wiley; 1986.Google Scholar
- 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.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
- 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