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Biomedical subjects

Katherine A Kendall

Publications and source records attributed to Katherine A Kendall.

11 recordsLinked to original sources
PubMed2006

Cricopharyngeal myotomy normalizes the opening size of the upper esophageal sphincter in cricopharyngeal dysfunction.

OBJECTIVE: The development of a cricopharyngeal dysfunction is associated with a hypertonic cricopharyngeus (CP) muscle. Therefore, CP myotomy has been advocated by some authors to be an essential part of repair of this condition. However, little objective data exists to show that there is improvement in the upper esophageal sphincter (UES) after CP myotomy. This study assesses the impact of CP myotomy on UES opening. STUDY DESIGN: Prospective. METHODS: Twenty patients treated at a university tertiary care center for cricopharyngeal dysfunction between 1998 and 2003 were identified. All patients underwent CP myotomy with or without Zenker's diverticulectomy. These patients had videofluoroscopic swallow studies before and after repair. The values of UES opening for 3 mL boluses from pre- and postrepair studies were compared with each other as well as with normal controls. Sixty percent (12/20) of the patients had a Zenker's diverticulum. Of these 12 patients, 5 had undergone previous attempts at surgical correction. Cricopharyngeal myotomy by way of an external approach, with or without Zenker's diverticulectomy, was performed in all patients by the senior author. RESULTS: Before Zenker's diverticulectomy and CP myotomy, the mean UES opening (n = 20) for a 3 mL bolus was 0.30 cm +/- 0.17, which was 57% of the mean of 60 normal controls (0.52 cm +/- 0.15) (P < .001). After repair, the mean UES opening for the same bolus size improved to 0.51 cm +/- 0.16 (P < .0001). The UES opening size in patients who have undergone repair is comparable with that of the normal controls (P > .05). CONCLUSIONS: UES opening size in patients with cricopharyngeal dysfunction is 57% of the size in normal controls. CP myotomy helps to normalize the UES opening in cricopharyngeal dysfunction repair.

Case-Control Studies↗
PubMed2004

Airway protection: evaluation with videofluoroscopy.

During videofluoroscopic swallowing studies performed in the lateral view, the arytenoid cartilages are seen to elevate and approximate the down-folding epiglottis, effectively closing the supraglottic larynx and protecting the airway. This mechanism may be incomplete or delayed in patients complaining of dysphagia and may lead to "penetration" of bolus material into the airway. This study evaluates the timing of supraglottic closure relative to the arrival of the bolus at the upper esophageal sphincter in 60 young control subjects and in 63 elderly control subjects without dysphagia. Event timing was measured in 0.01-s intervals from videofluoroscopic studies for two liquid bolus size categories. Results of the analysis revealed that, in most individuals, the arytenoid cartilages approximate the epiglottis prior to the arrival of the bolus at the upper esophageal sphincter. However, in both bolus size categories, there were individuals who achieved complete supraglottic closure after the bolus had arrived at the sphincter, but never greater than 0.1 s later. No delay in the timing of supraglottic closure relative to bolus arrival at the sphincter was found in the elderly subject group compared with the young subject group. The information from this study has allowed us to objectively determine if supraglottic closure timing is delayed in patients with dysphagia and to address any delay with strategies and exercises designed specifically to correct the delay. A case study is presented to illustrate the clinical significance of this study.

Adolescent↗
PubMed2004

Common medical conditions in the elderly: impact on pharyngeal bolus transit.

Deglutition in the elderly may be impacted by the sequelae of medical diseases. It is unknown if the long-term presence of common medical diseases, such as arthritis and hypertension, leads to changes in neurologic and muscular function and thus swallowing ability. The aim of this project was to determine if the duration of bolus pharyngeal transit in nondysphagic elderly individuals with chronic medical problems is longer than that measured in nondysphagic elderly individuals without medical problems. Videofluoroscopic swallowing studies were performed on 63 elderly subjects with a variety of well-controlled medical problems and on 23 elderly subjects with no medical problems. The mean timing of pharyngeal bolus transit was compared between the two groups. The relationship between the presence of medical problems and the likelihood of transit times prolonged beyond two standard deviations of the mean transit time found in 60 younger normal controls was also analyzed. Findings included significantly prolonged pharyngeal transit time in the group of subjects with medical problems compared with those subjects without medical problems for a small bolus size. Those individuals with hypertension demonstrated the most significant delays in bolus transit. The presence of medical problems did correlate with an increased likelihood of prolonged transit times. This preliminary study indicates that medical problems common in elderly populations are associated with a deterioration of swallowing function and that changes identified in elderly individuals may not be due to aging alone.

Age Factors↗
PubMed2004

Structural displacements affecting pharyngeal constriction in nondysphagic elderly and nonelderly adults.

This study investigated spatial displacement variables important to pharyngeal constriction and clearing in nondysphagic elderly subjects and a control group of nondysphagic younger adults. Height, weight, and body mass index (BMI) characteristics were determined for all subjects, who then underwent videofluoroscopic swallow studies. Measures obtained during swallow of a 20-cc bolus included hyoid and laryngeal displacement, unobliterated pharyngeal space at the point of maximum pharyngeal constriction, and pharyngeal width when maximally expanded during the swallow. Data were first examined to determine if elderly subjects with medical conditions common to an aged population differed from elderly subjects with no medical condition. No differences were identified and data for all elderly subjects were subsequently pooled for comparison to data for the nonelderly control group. Findings revealed no differences in maximum hyoid displacement between the groups. Significant differences were identified for larynx-to-hyoid approximation and for the measure representing unobliterated pharyngeal space at the point of maximum pharyngeal constriction. Elderly subjects did not elevate the larynx to the same extent, or clear the pharynx, as well as the younger control subjects. In addition, data suggested that the larynx was positioned lower and that the width of the pharynx maximally expanded was greater in elderly subjects. Implications of the data for swallowing function in the elderly are discussed.

Adolescent↗
PubMed2003

Sequence variability during hypopharyngeal bolus transit.

The pharyngeal phase of deglutition is considered to occur in a reflexive, preprogrammed fashion. Previous studies have determined a general sequence of events based on the mean timing of bolus transit and swallowing gestures. Individual variability has not been studied, however. The purpose of this study was to determine the amount of sequence variability that normally occurs during the hypopharyngeal phase of deglutition. Dynamic swallow studies from 60 normal volunteers were evaluated and event sequence variability was determined for 12 two-event sequences during swallowing of three bolus sizes. There was found to be some variability in event sequences for almost all events evaluated except for the following: (1) arytenoid cartilage elevation always began prior to opening of the upper esophageal sphincter, (2) the sphincter always opened prior to the arrival of the bolus at the sphincter, (3) larynx-to-hyoid approximation always occurred after the onset of upper esophageal sphincter opening, and (4) maximum pharyngeal constriction always occurred after maximal distension of the upper esophageal sphincter. Variability was more common during swallowing of the smallest bolus size. This information may be helpful in evaluating event coordination in patients with dysphagia.

Adolescent↗
PubMed2003

Severe obstructive airway disorders and diseases: vocal fold dysfunction.

Vocal Fold Dysfunction is a syndrome characterized by abnormal adduction of the focal folds during inspiration and is the cause of a wide spectrum of clinical manifestations ranging from mild inspiratory stridor to an inability to move any air. Patients present with varying degrees of intermittent respiratory difficulty, the most severe caused by intense laryngospasm. Distinguishing Vocal Fold Dysfunction from Refractory Asthma is important to avoid unnecessary pharmacotherapy and intubation. The diagnosis of Vocal Fold Dysfunction can only be made with certainty by flexible fiberoptic laryngoscopy while the patient is symptomatic. Pulmonary function studies and a lack of response to bronchodilators may provide clues to the diagnosis. Most patients with the condition can be managed by speech therapy and the use of breathing strategies that eliminate the abnormal vocal fold movement. Chronic laryngeal irritation may be a trigger for Vocal Fold Dysfunction and conditions such as laryngopharyngeal reflux disease should be aggressively managed in this patient population.

Humans↗
PubMed2002

Videofluoroscopic upper esophageal sphincter function in elderly dysphagic patients.

OBJECTIVES/HYPOTHESIS: The intent of the study was to identify and characterize abnormalities of the timing and extent of upper esophageal sphincter (UES) opening in an elderly population complaining of dysphagia. STUDY DESIGN: A retrospective review of dynamic swallow studies performed on patients greater than 65 years of age without an obvious medical or surgical cause for their dysphagia. METHODS: Measures of UES opening timing and extent in the patient population were compared with those from 60 young, normal control subjects and 23 elderly control subjects. The relationship of UES function and other swallowing abnormalities was also evaluated. RESULTS: No decrease in the size of UES opening was identified in the patient population. The coordination of UES opening relative to the position of the bolus in the pharynx was normal. UES opening was prolonged and was correlated with poor pharyngeal clearing suggestive of weak pharyngeal constriction. CONCLUSION: No primary abnormality of UES function was identified in this elderly dysphagic patient population.

Adult↗
PubMed2002

Oropharyngeal swallowing variability.

OBJECTIVES/HYPOTHESIS: The pharyngeal phase of deglutition is considered to occur in a reflexive, preprogrammed fashion. Previous studies have determined a general sequence of events based on the mean timing of bolus transit and swallowing gestures. However, individual variability has not been studied. The purpose of the present study was to evaluate the amount of sequence variability that normally occurs during the oropharyngeal phase of deglutition. STUDY DESIGN: Prospective analysis of conservative subjects. METHODS: Dynamic swallow studies from 60 normal volunteers were evaluated, and event sequence variability was determined around two event sequences during swallowing of three bolus sizes. RESULTS: There was found to be substantial variability in event sequences for all events analyzed. Variability was greater during a smaller bolus swallow. CONCLUSIONS: The evaluation of variability within the study group of individuals reveals the complexity of the swallowing mechanism and underscores the importance of not relying on general guidelines in evaluating the coordination of swallowing gestures in a given individual with dysphagia complaints.

Adult↗