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PubMed2005

[Pharyngeal size and collapsibility in patients with obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To study the pharyngeal cross-sectional area and collapsibility among the patients with obstructive sleep apnea hypopnea syndrome (OSAHS), simple snorers, and normal persons. METHODS: 171 patients with OSAHS, 44 with mild, 51 with moderate, and 56 with severe OSAHS, 47 simple snorers, and 47 healthy subjects underwent upper airway cross-sectional area measurement using acoustic pharyngometer at the conditions of functional residual capacity (FRC) and residual volume (RV) in the upright sitting position. RESULTS: When the lung volume decreased from the condition of FRC to the condition of RV the pharyngeal cross-sectional area decreased from 2.63 cm(2) +/- 0.42 cm(2) to 1.96 cm(2) +/- 0.35 cm(2) for the simple snorers, 2.70 cm(2) +/- 0.44 cm(2) to 1.78 cm(2) +/- 0.39 cm(2) for the mild OSAHS patients, from 2.62 cm(2) +/- 0.52 cm(2) to 1.79 cm(2) +/- 0.37 cm(2) for the moderate OSAHS patients, and from 2.57 cm(2) +/- 0.46 cm(2) to 1.75 cm(2) +/- 0.40 cm(2) for the severe OSAHS patients, all with higher decrease rates (33.93% +/- 11.81%, 31.13% +/- 10.76%, and 31.31% +/- 13.44%) than that of the normal persons (25.07% +/- 10.39%), smaller than that for the normal persons (21.11% +/- 8.19%, from 3.05 cm(2) +/- 0.6 cm(2) to 2.38 cm(2) +/- 0. 47 cm(2), all P < 0.05). The change ratios of the 3 OSAHS groups were significantly higher than that of the simple snorer group (all P < 0.01). This indicated that the pharynges of OSAHS patients were more collapsible. CONCLUSION: Snorers with or without apnea have smaller pharyngeal cross-sectional area than nonsnorers. The collapsibility of the upper airway is greater in both OSHAS patients and simple snorers than in healthy subjects.

Adult↗

PubMed1991

[Ecological study of the pharyngeal bacterial flora in patients with lung cancer].

We investigated the relationship between changes in pharyngeal bacterial flora and the immunological condition of 10 lung cancer patients before and after anti-cancer chemotherapy. There were significant differences in bacterial flora between normal subjects and patients. However, there were little differences in pharyngeal flora in patients before and after chemotherapy. In 4 out of the 10 lung cancer patients, the ratio of anaerobic bacteria/total bacteria of pharyngeal flora decreased. These 4 cases were in the non-responsive (NC, PD) group of anti-cancer chemotherapy. After administration of anti-cancer drugs, the ratio of anaerobic bacteria increased. No aerobic gram negative rods were isolated at any time during the observation period, because immunological suppression was mild. The results indicate the importance of surveillance for the immunological state of the hosts and changes in pharyngeal bacterial flora.

Adult↗

PubMed1989

Pharyngeal size and shape during wakefulness and sleep in patients with obstructive sleep apnoea.

Computed tomography has been used to study the pharyngeal airway during tidal breathing in wakefulness and during obstructive apnoeas in Non-REM sleep in patients with obstructive sleep apnoea. In supine subjects, contiguous transverse 10 mm sections were taken perpendicular to the posterior pharyngeal wall with a 2.1 s scan time. Studies during wakefulness showed that the narrowest section of the pharyngeal airspace was in the region posterior to the soft palate and that the minimal airway cross-sectional areas were significantly reduced in the group of patients with obstructive sleep apnoea compared to the group of control subjects without obstructive sleep apnoea. The studies during sleep showed that in all patients, the airspace posterior to the soft palate was a site of obstructive apnoeas. The length of the obstructed segment varied between patients, extending below the level of the soft palate in half the patient group. Airway narrowing and obstruction was due to posterior displacement of the soft palate and the tongue in the majority of patients, although lateral displacement of the pharyngeal walls was also observed. No occlusion was observed in the laryngopharynx although there was narrowing of oro- and laryngopharyngeal apertures below the site of obstruction during obstructive apnoeas. The size of the oropharyngeal airspace during wakefulness did not predict the presence of airway occlusion below the level of the soft palate when asleep. The variability between patients in the site(s) of upper airway obstruction during obstructive apnoeas have important implications for the choice of appropriate treatment in patients with obstructive sleep apnoea.

Adult↗

PubMed1979

Articulation skills and oral-nasal resonance in children with pharyngeal flaps.

Longitudinal data on speech sound acquisition and oral-nasal balance were analyzed in 52 children who had had pharyngeal flaps for velopharyngeal incompetency. These data were compared to similar data for a group of 48 children with cleft palates who had not required secondary management. Comparisons were made also between the pre- and post surgical performance of the group who had had pharyngeal flaps. Further comparisons were made between children who had surgery before six years. Analysis of data revealed that the children who required pharyngeal flaps lagged behind the group who did not in the development of acceptable resonance and articulation patterns. Further analysis showed that, for the post-pharyngeal flap group, there was an acceleration in the acquisition of acceptable sound production in the year immediately following surgery. The data suggested that children who had flaps before six years of age made faster gains in the development of articulation and acceptable resonance than did children who were treated after the age of six years.

Age Factors↗

PubMedDate not supplied

Pharyngeal function in patients with rheumatoid arthritis of the cervical spine and temporomandibular joint.

Pharyngeal function was studied in 31 patients with rheumatoid arthritis. Eighteen of these patients had dysphagia. Cervical spine abnormalities were present in 14. Destruction of the capitulum and/or ramus of the mandible was registered in 9. Pharyngeal dysfunction was revealed in 20. Patients with a vertical dislocation of the C1-C2 in relation to the occipital bone and patients with destruction of the capitulum and/or ramus of the mandible had an increased frequency of pharyngeal dysfunction. Pharyngeal dysfunction is thought to be due to mechanical factors and caused by derangements of muscular attachments and turning points.

Arthritis, Rheumatoid↗

PubMed1984

[Anatomo-clinical findings on the ascending pharyngeal artery].

Origin, width, course and twigs of the ascending pharyngeal artery are investigated on 63 head-helves. In about 80% this vessel is a twig from the external carotid artery or from a common trunc from this vessel. In 20% there is a twig from an other artery (In 4,8% the ascending pharyngeal artery is a twig of the internal carotid artery). The ascending pharyngeal artery is 1.57 (0.9-2.3) mm in width and its course is in the most cases straight, medial, mediorostral or laterorostral from the internal carotid artery in the parapharyngeal spaces. Number, course and width of the pharyngeal rami, the rami to the lymphatic nodes, to the superior sympathetic ganglion, the prevertebral tissues in the neighbourhood of the carotic canal, to the external cranial base, to the nasal part of the pharynx and to the hypoglossal canal are prepared and studied. The clinical value is discussed.

Arteries↗

PubMedDate not supplied

The lateral port control pharyngeal flap: a versatile approach to velopharyngeal insufficiency.

The surgical therapy for velopharyngeal incompetence has always been a challenging problem. In spite of the surgical choices of palatal pushback, pharyngeal flap, pharyngoplasty, muscle transfers, and pharyngeal wall implants, the reported failure rate has varied from 10% to 50%. A group of ten patients with velopharyngeal insufficiency is presented, two posttonsillectomy and adenoidectomy, three secondary to congenital deficiencies, and five following palatal and pharyngeal paralysis secondary to severe closed head injuries. The technique and experience with the lateral port control pharyngeal flap is discussed.

Adolescent↗

PubMed1983

[Development and structure of the lymphoepithelial pharyngeal ring in the Macacus rhesus].

The lymphoepithelial pharyngeal ring has been studied in fetuses and 6-8-month-old monkeys (Macacus rhesus) by means of macro- and microscopical methods. The pharyngeal, palatile and lingual tonsils and a poorly manifested laryngeal tonsil have been revealed. The anlage of the lingual tonsil occurs later than that of the other ones (in fetuses of 60-73 mm of the parietal-coccygeal length), when the palatile and pharyngeal tonsils are already inhabited with lymphocytes. By the end of the embryonal period, the main structural components are already formed in all the tonsils, but their functional activity is not yet manifested. During the postembryonic period certain differences are revealed in the tonsil structure, they are presented as the germinative centers formation, appearance of active macrophages and plasma cells. A close connection between the lingual, pharyngeal and laryngeal tonsils with the glandular tissue is noted.

Animals↗

PubMedDate not supplied

Acquired pharyngeal diverticulum following anterior cervical fusion operation.

We report an unusual case of a pharyngeal diverticulum arising as a result of extrusion of a bone graft inserted during anterior cervical fusion operation. The dense scar tissue at the site of extrusion of the bone graft probably caused traction on the posterior pharyngeal wall, with the development of a pharyngeal pouch. This is believed to be the first case with acquired pharyngeal diverticulum following anterior cervical fusion to be recorded in the literature.

Adult↗

PubMed1994

Repeatability and normal values for measurement of pharyngeal and tracheal pressures in exercising horses.

Repeatability of measurements of peak and mean tracheal and pharyngeal pressures in exercising horses was determined. Five athletically fit horses were subjected to repeated (n = 5) standardized exercise trials. Static pressures in the trachea, nasopharynx, and mask were determined. At least 96% of all mean pressure measurements were within 5 cm of H2O of the mean value for any horse. Peak pressure measurements were less repeatable, but at least 96% of all measurements were within 10 cm of H2O of the mean peak measurements for any horse. In 10 horses galloping at 14 m/s, the 95% confidence interval for peak tracheal and pharyngeal inspiratory pressures ranged from -40 to -50 cm of H2O and -20 to -26 cm of H2O, respectively. During expiration, the 95% confidence interval for peak tracheal and pharyngeal pressure at the same speed ranged from 15 to 28 cm of H2O and 10 to 24 cm of H2O respectively. During inspiration, horses with induced laryngeal hemiplegia had static pressure measurements generally outside that range. We conclude that determination of tracheal and pharyngeal pressures is a potentially useful adjunct for assessment of the proximal portion of the respiratory tract.

Animals↗

PubMed1993

Changes in pharyngeal dimensions effected by chin tuck.

This study measured the pharyngeal dimensions of 30 subjects when their heads were in an upright neutral position and in the chin-tucked position. Two videoprints of lateral radiographic views of the oral cavity and pharynx were made for each subject: one with the head in neutral position and one with the chin tucked. A 1-cm metal ruler was taped at midline on the front of each patient's neck to account for radiographic magnification of the image. Three angles and three distance measures were made on each videoprint. With the chin tucked, a posterior shift of anterior pharyngeal structures occurred, narrowing the laryngeal entrance and the distance from epiglottis to the pharyngeal wall and the laryngeal entrance, while widening the angle of the epiglottis to the anterior tracheal wall. This posterior shift with the chin tucked improves airway protection. Other clinical implications of these changes in pharyngeal dimensions are discussed.

Adult↗

PubMed1993

Brainstem infarct with pharyngeal dysmotility and paralyzed vocal cord: management with a multidisciplinary approach.

An unusual case of right posterior brainstem infarction with isolated deficits of severe dysphagia and ataxia is presented. Neurological examination revealed dysfunction of the pharyngeal and laryngeal branches of cranial nerves IX, X, and a paralyzed right vocal cord. The patient was unable to swallow 1/4 teaspoon of applesauce. Modified barium swallow revealed extremely sluggish pharyngeal peristalsis and absent swallowing reflex. Percutaneous esophageal gastrostomy tube was inserted and an intensive dysphagia rehabilitation program was initiated. Pharyngeal-phase-oriented protocol was used. Results were significantly improved compensatory pharyngeal and laryngeal function with restoration of swallowing and no aspiration. This case illustrates successful management of dysphagia associated with brainstem infarction and the benefits of a coordinated multidisciplinary protocol.

Aged↗

PubMed1996

Laryngeal and pharyngeal dysfunction in horses homozygous for hyperkalemic periodic paralysis.

OBJECTIVE: Evaluate histories, clinical signs, and laboratory data of 69 horses homozygous by DNA testing for hyperkalemic periodic paralysis (HPP). DESIGN: Cohort study. SAMPLE POPULATION: 69 of 189 horses testing homozygous for HPP between October 1992 and November 1994. PROCEDURE: Questionnaires addressing signalment, training regimes, medical history, and current status of affected horses were sent to owners, trainers, or attending veterinarians. Data from completed questionnaires were tabulated and evaluated, using descriptive statistics. RESULTS: Sixty-nine (37%) of 189 questionnaires were completed and returned. Clinical episodes of muscle weakness or paralysis varied in severity and frequency from mild muscle fasciculations to recumbency and death. Sixty-three of 68 HPP-affected horses were reported to have had stridor associated with exercise, excitement, stress, or episodes of muscle paralysis. Common endoscopic findings in affected horses included pharyngeal collapse, pharyngeal edema, laryngopalatal dislocation, and laryngeal paralysis. Twelve of 27 horses receiving acetazolamide had decreases in stridor while receiving medication. CLINICAL IMPLICATIONS: Most horses testing homozygous for HPP had clinical signs associated with pharyngeal and laryngeal dysfunction. Hyperkalemic periodic paralysis should be included on a differential list for horses examined for signs of laryngeal or pharyngeal dysfunction or stridor. Treatment with acetazolamide may help to control respiratory tract signs associated with this disease.

Animals↗

PubMedDate not supplied

[The frequency of Streptococcus anginosus in the pharyngeal exudate from children and its differentiation from other beta-hemolytic streptococci].

UNLABELLED: S. anginosus is a commensal of the oro-pharyngeal mucous membrane without any signification for the local pathology. Ignoring the existence of beta-haemolytic colonies of this species, the risk to report the presence of some beta-haemolytic streptococci that actually belong to the normal flora exists. The antigenic identifications of beta-haemolytic streptococci maintain the confusion either, S. anginosus being able to react with specific sera anti group G, C or A. In our study, two identification criteria out of those available demonstrated a high value: the small or very small colonies' size, especially in secondary cultures and the production of acetoin (Voges-Proskauer test). S. anginosus was isolated with a quite great frequency in pharyngeal exudate from children: 41 strains out of 90 strains of beta-haemolytic non-group A streptococci were S. anginosus. Antigenically they belonged, in numerical order to groups C, G, F or they were ungroupable. IN CONCLUSION: The microbiologist has to identify, but not to report the presence of S. anginosus in pharyngeal exudate, it being a normal component of the oro-pharyngeal flora. Doing so, a better evaluation of the clinical signification of the other beta haemolytic streptococci's non group A will be possible.

Antigens, Bacterial↗

PubMed1998

Mathematical modeling of normal pharyngeal bolus transport: a preliminary study.

Dysphagia (difficulty in swallowing) is a common clinical symptom associated with many diseases, such as stroke, multiple sclerosis, neuromuscular diseases, and cancer. Its complications include choking, aspiration, malnutrition, cachexia, and dehydration. The goal in dysphagia management is to provide adequate nutrition and hydration while minimizing the risk of choking and aspiration. It is important to advance the individual toward oral feeding in a timely manner to enhance the recovery of swallowing function and preserve the quality of life. Current clinical assessments of dysphagia are limited in providing adequate guidelines for oral feeding. Mathematical modeling of the fluid dynamics of pharyngeal bolus transport provides a unique opportunity for studying the physiology and pathophysiology of swallowing. Finite element analysis (FEA) is a special case of computational fluid dynamics (CFD). In CFD, the flow of a fluid in a space is modeled by covering the space with a grid and predicting how the fluid moves from grid point to grid point. FEA is capable of solving problems with complex geometries and free surfaces. A preliminary pharyngeal model has been constructed using FEA. This model incorporates literature-reported, normal, anatomical data with time-dependent pharyngeal/upper esophageal sphincter (UES) wall motion obtained from videofluorography (VFG). This time-dependent wall motion can be implemented as a moving boundary condition in the model. Clinical kinematic data can be digitized from VFG studies to construct and test the mathematical model. The preliminary model demonstrates the feasibility of modeling pharyngeal bolus transport, which, to our knowledge, has not been attempted before. This model also addresses the need and the potential for CFD in understanding the physiology and pathophysiology of the pharyngeal phase of swallowing. Improvements of the model are underway. Combining the model with individualized clinical data should potentially improve the management of dysphagia.

Deglutition↗

PubMed2004

Community-based surveillance in the united states of macrolide-resistant pediatric pharyngeal group A streptococci during 3 respiratory disease seasons.

BACKGROUND: In 2001, a total of 48% of pharyngeal group A streptococci (GAS) from Pittsburgh children were macrolide resistant. We assessed macrolide resistance, resistance genes, and emm types among GAS in the United States. METHODS: In prospective, multicenter, community-based surveillance of pharyngeal GAS recovered from children 3-18 years old during 3 respiratory seasons (the 2000-2001 season, the 2001-2002 season, and the 2002-2003 season), GAS were tested for macrolide resistance and underwent emm gene sequencing. Macrolide-resistant GAS were tested for resistance to clindamycin, and resistance genes were determined. RESULTS: Erythromycin resistance was observed in 4.4% of isolates from the 2000-2001 season, 4.3% from the 2001-2002 season, and 3.8% from the 2002-2003 season (P=.80). Clindamycin resistance was found in 1.04% of isolates; annual rates of clindamycin resistance were stable (P=.75). The predominant resistance genotype each year was mef A (65%-76.9%; overall, 70.3%). Resistant isolates included strains representing 8-11 different emm types each year. Heterogeneity of emm subtypes, resistance genes, and clindamycin resistance was evident among resistant isolates within some emm types. Geographic variability in resistance rates was present each year. CONCLUSIONS: The macrolide resistance rate among pharyngeal GAS was <5% and was stable over the 3 seasons. However, rates varied among sites each year. There was no evidence of spread of a specific resistant clone, increasing clindamycin resistance, or escalation in median erythromycin MICs.

Child↗

PubMed2002

The male predisposition to pharyngeal collapse: importance of airway length.

Obstructive sleep apnea is an important disorder because of both its prevalence and its cardiovascular and neurocognitive sequelae. Despite the fact that male sex is a major risk factor for this disorder, the mechanisms underlying this predisposition are unclear. To understand the pathophysiologic basis of the male predisposition for pharyngeal collapse, we performed a detailed analysis of the anatomic and physiologic features of the upper airway in a cohort of normal and near-normal subjects (equal number of men and women). Although no important physiologic (genioglossal electromyogram, airflow resistance) differences were observed between sexes, a number of anatomic differences were apparent. The pharyngeal airway length was substantially longer in men compared with women. There was also an increased cross-sectional area of the soft palate and an increased airway volume in men compared with women. Using signal-averaged anatomic data from male and female subjects, we developed representative male and female finite element airway models. This model demonstrated the male airway to be substantially more collapsible than the female airway, solely on the basis of anatomic differences. This study suggests that the male predisposition to pharyngeal collapse is anatomically based, primarily as the result of an increased length of vulnerable airway as well as increased soft palate size.

Adult↗

PubMed1990

Nonclosure of pharyngeal muscle after laryngectomy.

A prospective study was carried out to evaluate a new technique of pharyngeal repair following laryngectomy. The purpose of this study was to see whether satisfactory healing would occur if the pharyngeal constrictors were not sutured across the closure in the pharynx. If healing proved to be satisfactory the procedure might eliminate the need for primary or secondary myotomy or pharyngeal plexus neurectomy to facilitate tracheoesophageal speech. The results indicate that healing is as good in the group who did not have muscle closure as in those who did.

Evaluation Studies as Topic↗