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Eating, drinking and swallowing in the context of older age
Published in Rebecca Allwood, Working with Communication and Swallowing Difficulties in Older Adults, 2022
The critical objective of this phase is to get the bolus through the pharynx into the oesophagus without it or parts of it entering the airway and potentially being aspirated (aspiration refers to the bolus passing below the level of the vocal cords and entering the lungs). In order to achieve maximum closure of the airway, the hyoid bone and larynx are pulled upwards and forwards, which leads to deflection of the epiglottis over the laryngeal vestibule; the vocal cords close over the glottis, and closure of the false vocal cords superior to the vocal cords provides additional protection.
Anatomy overview
Published in Stephanie Martin, Working with Voice Disorders, 2020
The larynx is innervated by branches of the vague nerve on each side. Sensory innervations to the glottis and laryngeal vestibule is by the internal branch of the superior laryngeal nerve. The external branch of the superior laryngeal nerve innervates the cricothyroid muscles. There are eight extrinsic muscles, four of which lie above the level of the hyoid – the suprahyoid muscles, which act principally to elevate the larynx and support the hyoid bone. Four lie below the hyoid – the infrahyoid muscles, which act as laryngeal depressors. The latter are particularly important in lengthening the vocal tract, which has a significant effect on vocal resonance. Detailed descriptions of the extrinsic laryngeal muscles can be found in a number of texts, but for the purposes of this chapter an outline of the muscles, their function and innervation are given in Table 1.4.
Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The laryngeal cavity is shaped like an hourglass, composed of the laryngeal vestibule above the vestibular folds (false vocal folds), and the infraglottic cavity inferior to the vocal folds (which include the vocal ligaments) (Plate 3.44). The vestibular fold and the vocal fold (true vocal fold) are separated by a space called the laryngeal ventricle, which is quite variable in extent. The glottis includes the vocal folds and the space between them, which is designated the rima glottidis.
Training for videofluoroscopic swallowing analysis: A systematic review
Published in International Journal of Speech-Language Pathology, 2021
Ann Edwards, Elspeth Froude, Gabriella Sharpe, Paul Carding
Interrater reliability increased over the 8-week period, although the authors noted that the small participant numbers, combined with the decrease of participants (experienced clinicians exited the study after reaching competency), potentially widened confidence intervals and negatively affected the intraclass correlation coefficient (ICC) results. Agreement remained poor for measures of airway closure after training, and the authors suggested that this may relate to perceptual difficulty in detecting grey-scale changes of the laryngeal vestibule, particularly in uncontrolled environments. The researchers also collected measures of self-confidence and perceived pressure relating to the analysis: as accuracy and speed increased, self-confidence increased, and perceived pressure decreased respectively. This study highlights the variability that can occur in training depending on the swallowing parameter that is being assessed. It also provides useful data about the participant experience in training.
Correlation between dysphonia and dysphagia evolution in amyotrophic lateral sclerosis patients
Published in Logopedics Phoniatrics Vocology, 2021
Chiara Mezzedimi, Enza Vinci, Fabio Giannini, Serena Cocca
FEES was performed with a fiberoptic rhinopharyngoscope for studying the physiology and physiopathology of certain stages of swallowing, particularly the pharyngeal stage. As far as concerns the static investigation, three main positions were performed for the tip of the endoscope: rhino-pharyngeal, upper position and lower position. In the upper position (with the endoscope next to the velum palati), it was possible to detect stagnation of secretion in the glosso-epiglottic valleculae, the pyriform recesses, the interarytenoid area and the laryngeal vestibule. The lower position (the endoscope is placed at the laryngeal aditus) was tested by simply inviting the patient to cough, swallow saliva and carry out a Valsalva maneuver. Static evaluation of the morphology and function of the upper airways and upper digestive tract was followed by a dynamic evaluation of swallowing, administering a bolus to the patient. At least four bolus types were administered: 5 ml of thin liquid from a spoon, thin liquid from a cup (self-administered), 5 ml of a semisolid from a spoon, and a cookie.
Objective measurement of acoustic intensity of coughing for clearance of penetration and aspiration on video-fluoroscopy
Published in International Journal of Speech-Language Pathology, 2021
Emma Wallace, Phoebe Macrae, Maggie-Lee Huckabee
Instances of airway invasion and reflexive coughing were evaluated by two trained speech- language pathologists, using the judgement criteria (Table I). Evaluations of the cough responses were conducted independently. In the case of any disagreement, discussion was undertaken to reach a consensus, or the opinion of a third speech-language pathologist was sought. However, in the current study, this was not necessary as 100% consensus was achieved in the initial evaluation. The laryngeal vestibule was defined as the space above the vocal cords, below the underside of the epiglottis, and contained laterally by the aryepiglottic folds. For a cough to be judged as effective, all aspirated or penetrated material must be expelled from the laryngeal vestibule.