Submitted on May 15, 2007
Accepted on December 24, 2007
Respiration during Feeding on Solid Food: Alterations in Breathing during Mastication, Pharyngeal Bolus Aggregation and Swallowing
Koichiro Matsuo1, Karen M Hiiemae2, Marlis Gonzalez-Fernandez1, and Jeffrey B Palmer3*
1 Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States
2 Bioengineering and Neuroscience, Syracuse University, Syracuse, New York, United States
3 Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States; Otolaryngology-Head and Neck Surgery, and Center for Functional Anatomy and Evolution, Johns Hopkins University, Baltimore, Maryland, United States
* To whom correspondence should be addressed. E-mail: jpalmer{at}jhmi.edu.
During feeding, solid food is chewed and propelled to the oropharynx where the bolus gradually aggregates while the larynx remains open and breathing continues. The aggregated bolus in the valleculae is exposed to respiratory airflow, yet aspiration is rare in healthy individuals. The mechanism for preventing aspiration during bolus aggregation is unclear. One possibility is that alterations in the pattern of respiration during feeding could help prevent inhalation of food from the pharynx. We hypothesized that respiration was inhibited during bolus aggregation in the valleculae. Videofluorography was performed on 10 healthy volunteers eating solid foods with barium. Respiration was monitored concurrently with plethysmography and nasal air pressure. The timing of events during mastication, food transport, pharyngeal bolus aggregation, and swallowing were measured in relation to respiration. Respiratory cycle duration decreased during chewing (P < 0.001) but increased with swallowing (P < 0.001). During 66 recordings of vallecular bolus aggregation, there was inspiration in 8%, expiration in 41%, a pause in breathing in 17%, and multiple phases (including inspiration) in 35%. Out of 98 swallows, 47% started in the expiratory phase and 50% started during a pause in breathing, irrespective of bolus aggregation in the valleculae. Plethysmography was better than nasal manometry for determining the end of active expiration during feeding and swallowing with solid food. The hypothesis is rejected in that respiration was not inhibited during bolus aggregation. These findings suggest that airflow through the pharynx does not have a role in preventing aspiration during bolus aggregation in the oropharynx.
