Faculty Collaboration Database

Definition and implications of novel pharyngo-glottal reflex in human infants using concurrent manometry ultrasonography. Am J Gastroenterol 2009 Oct;104(10):2572-82

Date

07/16/2009

Pubmed ID

19603008

Pubmed Central ID

PMC3791891

DOI

10.1038/ajg.2009.411

Scopus ID

2-s2.0-70350508343 (requires institutional sign-in at Scopus site)   53 Citations

Abstract

OBJECTIVES: Glottal relationships during swallowing dominate the etiology of dysphagia. We investigated the pharyngo-glottal relationships during basal and adaptive swallowing.

METHODS: Temporal changes in glottal closure kinetics (frequency, response latency, and duration) with spontaneous and adaptive pharyngeal swallows were defined in 12 infants using concurrent pharyngoesophageal manometry and ultrasonography of the glottis.

RESULTS: Frequency, response latency, and duration of glottal closure with spontaneous swallows (n=53) were 100%, 0.27+/-0.1 s, and 1+/-0.22 s, respectively. The glottis adducted earlier (P<0.0001 vs. upper esophageal sphincter relaxation) within the same respiratory phase as swallow (P=0.03). With pharyngeal provocations (n=41), glottal adduction (pharyngo-glottal closure reflex (PGCR)) was noted first and then again with pharyngeal reflexive swallow (PRS). The frequency, response latency, and duration of glottal closure with PGCR were 100%, 0.56+/-0.13 s, and 0.52+/-0.1 s, respectively. Response latency to PRS was 3.24+/-0.33 s; the glottis adducted 97% within 0.36+/-0.08 s in the same respiratory phase (P=0.03), and remained adducted for 3.08+/-0.71 s. Glottal adduction was the quickest with spontaneous swallow (P=0.04 vs. PGCR), and the duration was the longest during PRS (P<0.005 vs. PGCR or spontaneous swallow).

CONCLUSIONS: Glottal adduction during basal or adaptive swallowing reflexes occurs in either respiratory phase, thus ensuring airway protection against pre-deglutitive or deglutitive aspiration. The independent existence and magnitude (duration of adduction) of PGCR suggests a hypervigilant state of the glottis in preventing aspiration during swallowing or during high gastroesophageal reflux events. Investigation of pharyngeal-glottal relationships with the use of noninvasive methods may be more acceptable across the age spectrum.

Author List

Jadcherla SR, Gupta A, Wang M, Coley BD, Fernandez S, Shaker R

Author

Reza Shaker MD Assoc Provost, Sr Assoc Dean, Ctr Dir, Chief, Prof in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adaptation, Physiological
Chi-Square Distribution
Deglutition
Electromyography
Female
Glottis
Humans
Infant, Newborn
Male
Manometry
Pharynx
Reflex
Respiration
Time Factors
Ultrasonography