PubMed · 11720011
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W C Ngeow. 2001-10-27. Ingested denture.. https://doi.org/10.1038/sj.bdj.4801199a
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To understand the phenomenon of sleep-related gastroesophageal reflux, it is necessary to understand how sleep alters basic physiologic mechanisms. Several mechanisms are depressed during sleep, which may lead to prolonged acid contact times. These mechanisms include the warning signal of heartburn, the frequency of swallowing, and the suppression of salivary secretion. Several investigations have shown that esophageal acid clearance is significantly prolonged during sleep, compared with the waking state; this is true even when sleeping subjects are compared with awake subjects in the supine position. Studies have also demonstrated an enhanced risk of pulmonary aspiration of gastric contents associated with depressed consciousness, likely related to the depression of upper airway protective mechanisms such as cough and swallowing. Available data also support the theory that certain endogenous response mechanisms involving the central nervous system that protect against the potentially damaging consequences of prolonged acid mucosal contact are invoked during sleep.
Infant and pediatric feeding and swallowing disorders may result from a variety of diseases, including pneumonia, neurologic disorders, and gastroesophageal reflux disease (GERD). The flexible endoscopic evaluation of swallowing (FEES) technique has been successfully used for evaluation in adult and pediatric swallowing disorders. A recent study demonstrated that FEES with sensory testing can be incorporated into evaluation of pediatric cases with relative safety. As seen in adults, pediatric patients with an increased laryngopharyngeal sensory threshold (LPST) have a significantly higher likelihood of laryngeal reflux penetration and aspiration during a feeding assessment. Additionally, the study using sensory testing found a possible correlation between a history of GERD and an increased LPST. Thus, further examination using LPST testing in pediatric patients is recommended.
Mastication, swallowing, breath flow, and aroma release were measured simultaneously in vivo using electromyography, electroglottography, a turbine air flow meter, and the MS-Nose, respectively. Signals were synchronized either electronically or by aligning the nasal airflow data with the breath by breath release of acetone. Chewing affected nasal airflow, with the flow fluctuations following the mastication pattern. Data analysis suggested that air was pumped out of the mouth into the throat with each chew, and the mean volume was 26 mL. Aroma release was associated with the pulses of air pumped from the mouth with each chew. During swallowing, there was no nasal airflow, but after swallowing, aroma release was evident. The volume of the retronasal route was estimated at 48 mL when swallowing and 72 mL when samples were chewed. The combination of techniques shows the effects of physiological processes on aroma release.