Doeltgen Sebastian Heinrich, Ong Ellisa, Scholten Ingrid, Cock Charles, Omari Taher
1 Department of Speech Pathology, School of Health Sciences, Flinders University, Bedford Park, Australia.
2 Department of Gastroenterology, School of Medicine, Flinders University, Bedford Park, Australia.
Otolaryngol Head Neck Surg. 2017 Nov;157(5):816-823. doi: 10.1177/0194599817708173. Epub 2017 Jun 13.
Objective To quantify the effects of 2 swallowing maneuvers used in dysphagia rehabilitation-the Mendelsohn maneuver and effortful swallowing-on pharyngoesophageal function with novel, objective pressure-flow analysis. Study Design Evaluation of intervention effects in a healthy control cohort. Setting A pharyngoesophageal motility research laboratory in a tertiary education facility. Subjects Twelve young healthy subjects (9 women, 28.6 ± 7.9 years) from the general public, without swallowing impairment, volunteered to participate in this study. Methods Surface electromyography from the floor-of-mouth musculature and high-resolution impedance manometry-based pressure flow analysis were used to assess floor-of-mouth activation and pharyngoesophageal motility, respectively. Subjects each performed 10 noneffortful control swallows, Mendelsohn maneuver swallows, and effortful swallows, with a 5-mL viscous bolus. Repeated measures analyses of variance was used to compare outcome measures across conditions. Results Effortful and Mendelsohn swallows generated greater floor-of-mouth contraction ( P = .001) and pharyngeal pressure ( P < .0001) when compared with control swallows. There were no changes at the level of the upper esophageal sphincter, except for a faster opening to maximal diameter during maneuver swallows ( P = .01). The proximal esophageal contractile integral was reduced during Mendelsohn swallows ( P = .001). Conclusion Effortful and Mendelsohn maneuver swallows significantly alter the pharyngoesophageal pressure profile. Faster opening of the upper esophageal sphincter may facilitate bolus transfer during maneuver swallows; however, reduced proximal esophageal contractility during Mendelsohn maneuver swallows may impair bolus flow and aggravate dysphagic symptoms.
目的 采用新颖的客观压力-流量分析方法，量化吞咽困难康复中使用的两种吞咽动作——门德尔松动作和用力吞咽——对咽食管功能的影响。研究设计 对健康对照队列中的干预效果进行评估。研究地点 一所高等教育机构中的咽食管动力研究实验室。研究对象 12名来自普通人群的年轻健康受试者（9名女性，年龄28.6±7.9岁），无吞咽障碍，自愿参与本研究。方法 分别使用口底肌肉组织的表面肌电图和基于高分辨率阻抗测压的压力-流量分析来评估口底激活和咽食管动力。受试者每人用5毫升粘性食团进行10次非用力对照吞咽、门德尔松动作吞咽和用力吞咽。采用重复测量方差分析比较不同条件下的结果指标。结果 与对照吞咽相比，用力吞咽和门德尔松吞咽产生了更大的口底收缩（P = .001）和咽部压力（P < .0001）。除了在动作吞咽期间上食管括约肌开口到最大直径的速度更快外（P = .01），上食管括约肌水平没有变化。在门德尔松吞咽期间近端食管收缩积分降低（P = .001）。结论 用力吞咽和门德尔松动作吞咽显著改变了咽食管压力曲线。上食管括约肌更快的开口可能有助于动作吞咽期间食团的转移；然而，门德尔松动作吞咽期间近端食管收缩性降低可能会损害食团流动并加重吞咽困难症状。
