Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction

Simultaneous videoradiography and solid-state manometry (videomanometry) was performed in 8 patients (4 women, 4 men; age range = 46-81 years, mean age = 70 years) with pharyngeal dysfunction. Five patients had severe pharyngeal dysfunction with frequent misdirected swallows. Three patients had moderate pharyngeal dysfunction with delayed initiation of pharyngeal swallow. Three different swallowing techniques were used: supraglottic swallow, effortful swallow, and chin tuck. Ten video radiographic variables and six manometric variables were analyzed. Contrast media penetration to the airways was analyzed regarding number of events and level of penetration. Supraglottic swallow, effortful swallow, and chin tuck did not reduce the number of misdirected swallows, but effortful swallow and chin tuck significantly (p = 0.008) reduced the depth of contrast penetration into the larynx and trachea. There was no significant improvement of pharyngeal retention. Chin tuck reduced the distance between the thyroid and the hyoid and the distance between the mandible and the hyoid. No other measured variable was significantly altered. This study shows that none of the different swallowing techniques reduced the number of misdirected swallows. However, there was a significantly reduced depth of the misdirected swallows. The swallowing techniques did not seem to prevent the occurrence of retention or improve weak pharyngeal constrictor muscles in this group of patients with severe to moderate dysfunction