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Swallow Event Sequencing: Comparing Healthy Older and Younger Adults

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Abstract

Previous research has established that a great deal of variation exists in the temporal sequence of swallowing events for healthy adults. Yet, the impact of aging on swallow event sequence is not well understood. Kendall et al. (Dysphagia 18(2):85–91, 2003) suggested there are 4 obligatory paired-event sequences in swallowing. We directly compared adherence to these sequences, as well as event latencies, and quantified the percentage of unique sequences in two samples of healthy adults: young (< 45) and old (> 65). The 8 swallowing events that contribute to the sequences were reliably identified from videofluoroscopy in a sample of 23 healthy seniors (10 male, mean age 74.7) and 20 healthy young adults (10 male, mean age 31.5) with no evidence of penetration–aspiration or post-swallow residue. Chi-square analyses compared the proportions of obligatory pairs and unique sequences by age group. Compared to the older subjects, younger subjects had significantly lower adherence to two obligatory sequences: Upper Esophageal Sphincter (UES) opening occurs before (or simultaneous with) the bolus arriving at the UES and UES maximum distention occurs before maximum pharyngeal constriction. The associated latencies were significantly different between age groups as well. Further, significantly fewer unique swallow sequences were observed in the older group (61%) compared with the young (82%) (χ2 = 31.8; p < 0.001). Our findings suggest that paired swallow event sequences may not be robust across the age continuum and that variation in swallow sequences appears to decrease with aging. These findings provide normative references for comparisons to older individuals with dysphagia.

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Acknowledgements

The authors would like to thank Shelby Norman for her assistance in reliability analysis for the healthy older dataset.

Funding

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

Author information

Authors and Affiliations

  1. Department of Communicative Sciences and Disorders, NYU Steinhardt, New York, NY, USA

    Erica G. Herzberg & Sonja M. Molfenter

  2. Mount Sinai Beth Israel, New York, NY, USA

    Cathy L. Lazarus

  3. Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada

    Catriona M. Steele

  4. Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada

    Catriona M. Steele

Authors
  1. Erica G. Herzberg
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  2. Cathy L. Lazarus
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  3. Catriona M. Steele
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  4. Sonja M. Molfenter
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Corresponding author

Correspondence to Erica G. Herzberg.

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Conflict of interest

This work was presented as a poster presentation at the 2018 Dysphagia Research Society Conference (DRS). No other conflicts of interest to disclose.

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.

Appendix

Appendix

See Figs. 1, 2, 3, and 4.

Fig. 1
figure 1

Percentage of swallows in the healthy older dataset adhering to obligatory sequence of laryngeal elevation before UES opening by trial, bolus size, and viscosity

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Fig. 2
figure 2

Percentage of swallows in the healthy older dataset adhering to obligatory sequence of UES opening before or with bolus at UES by trial, bolus size, and viscosity

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Fig. 3
figure 3

Percentage of swallows in the healthy older dataset adhering to obligatory sequence of UES opening before hyolaryngeal approximation by trial, bolus size, and viscosity

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Fig. 4
figure 4

Percentage of swallows in the healthy older dataset adhering to obligatory sequence of UES max before Max PC by trial, bolus size, and viscosity

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Herzberg, E.G., Lazarus, C.L., Steele, C.M. et al. Swallow Event Sequencing: Comparing Healthy Older and Younger Adults. Dysphagia 33, 759–767 (2018). https://doi.org/10.1007/s00455-018-9898-3

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  • DOI: https://doi.org/10.1007/s00455-018-9898-3

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