Volitional augmentation of upper esophageal sphincter opening during swallowing

TLDR

Eight healthy volunteers underwent synchronized videofluoroscopy and manometry while swallowing 1 ml and 10 ml of liquid barium, with hyoid and laryngeal movements, UES dimensions, and intraluminal pressures recorded at 1/30‑s intervals before and after training in the Mendelsohn maneuver. The Mendelsohn maneuver prolonged laryngeal and hyoid anterior‑superior excursion, delayed UES closure by maintaining traction on the anterior wall, but did not alter the onset of pharyngeal contraction, indicating that volitional augmentation of UES opening is achievable and may inform biofeedback therapies for dysphagia.

Abstract

Studies were done on eight normal subjects with synchronized videofluoroscopy and manometry to facilitate a biomechanical analysis of the extent and mechanism of voluntary augmentation of upper esophageal sphincter (UES) opening during swallowing. Movements of the hyoid and larynx, dimensions of sphincter opening, and intraluminal pressure events were determined at 1/30-s intervals during swallows of 1 and 10 ml of liquid barium. Swallows of each volume were obtained both before and after subjects were taught a maneuver designed to augment UES opening, the Mendelsohn maneuver (voluntary prolongation of laryngeal excursion at the midpoint of the swallow). At either volume, use of the maneuver increased the duration of the anterior-superior excursion of the larynx and hyoid and consequently delayed sphincter closure by maintaining traction on the anterior sphincter wall. The onset of the pharyngeal contraction (the event normally culminating in sphincter closure) was not affected by the maneuver. We conclude that swallow-related hyoid motion, laryngeal motion, and UES opening are subject to volitional augmentation, supporting the notion that biofeedback techniques can be used to modify impaired swallowing.