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Effect of aging on hypopharyngeal safe volume and the aerodigestive reflexes protecting the airways

Authors

  • Kulwinder S. Dua MD,

    1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
    2. VA Medical Center, Milwaukee, Wisconsin, U.S.A.
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  • Sri Naveen Surapaneni MD,

    1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
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  • Shiko Kuribayashi MD,

    1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
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  • Mohammed Hafeezullah MD,

    1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
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  • Reza Shaker MD

    Corresponding author
    1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
    • Send correspondence to Reza Shaker, MD, Division of Gastroenterology and Hepatology, 9200 West Wisconsin Avenue, Medical College of Wisconsin, Milwaukee, WI 53226. E-mail: rshaker@mcw.edu

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  • Author contributions: Kulwinder S. Dua: Study concept and design; acquisition, analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis; obtained funding, technical, or material support; study supervision. Sri Naveen Surapaneni: Acquisition of data, analysis and interpretation of data, statistical analysis, technical support. Shiko Kuribayashi: Acquisition of data, analysis of data, statistical analysis, technical support. Mohammed Hafeezullah: Acquisition of data, technical support. Reza Shaker: Study concept and design; interpretation of data; critical revision of the manuscript for important intellectual content; obtained funding, technical, or material support; study supervision.

  • This work is supported in part by NIH grants 1P01DK068051-01A1 and 5RO1DK025731.

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Studies on young volunteers have shown that aerodigestive reflexes are triggered before the maximum volume of fluid that can safely collect in the hypopharynx before spilling into the larynx is exceeded (hypopharyngeal safe volume [HPSV]). The objective of this study was to determine the influence of aging on HPSV and pharyngo-glottal closure reflex (PGCR), pharyngo-UES contractile reflex (PUCR), and reflexive pharyngeal swallow (RPS).

Study Design

Comparison between two groups of different age ranges.

Methods

Ten young (25 ± 3 standard deviation [SD] years) and 10 elderly (77 ± 3 SD years) subjects were studied. PGCR, PUCR, and RPS were elicited by perfusing water into the pharynx rapidly and slowly. HPSV was determined by abolishing RPS with pharyngeal anesthesia.

Results

Frequency–elicitation of PGCR and PUCR were significantly lower in the elderly compared to the young during slow water perfusion (47% vs. 97% and 40% vs. 90%, respectively, P < .001). RPS was absent in five of the 30 (17%) slow injections in the elderly group. In these elderly subjects, HPSV was exceeded and laryngeal penetration of the water was seen. The threshold volume to elicit PGCR, PUCR, and RPS was significantly lower than the HPSV during rapid injections. Except for RPS, these volumes were also significantly lower than HPSV during slow injections.

Conclusions

PGCR, PUCR, and RPS reflexes are triggered at a threshold volume significantly lower than the HPSV in both young and elderly subjects. Lower frequency–elicitation of PGCR, PUCR, and RPS in the elderly can predispose them to the risks of aspiration.

Level of Evidence

4. Laryngoscope, 124:1862–1868, 2014

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