Biomechanical Quantification of Mendelsohn Maneuver and Effortful Swallowing on Pharyngoesophageal Function

Otolaryngol Head Neck Surg. 2017 Nov;157(5):816-823. doi: 10.1177/0194599817708173. Epub 2017 Jun 13.

Abstract

Objective To quantify the effects of 2 swallowing maneuvers used in dysphagia rehabilitation-the Mendelsohn maneuver and effortful swallowing-on pharyngoesophageal function with novel, objective pressure-flow analysis. Study Design Evaluation of intervention effects in a healthy control cohort. Setting A pharyngoesophageal motility research laboratory in a tertiary education facility. Subjects Twelve young healthy subjects (9 women, 28.6 ± 7.9 years) from the general public, without swallowing impairment, volunteered to participate in this study. Methods Surface electromyography from the floor-of-mouth musculature and high-resolution impedance manometry-based pressure flow analysis were used to assess floor-of-mouth activation and pharyngoesophageal motility, respectively. Subjects each performed 10 noneffortful control swallows, Mendelsohn maneuver swallows, and effortful swallows, with a 5-mL viscous bolus. Repeated measures analyses of variance was used to compare outcome measures across conditions. Results Effortful and Mendelsohn swallows generated greater floor-of-mouth contraction ( P = .001) and pharyngeal pressure ( P < .0001) when compared with control swallows. There were no changes at the level of the upper esophageal sphincter, except for a faster opening to maximal diameter during maneuver swallows ( P = .01). The proximal esophageal contractile integral was reduced during Mendelsohn swallows ( P = .001). Conclusion Effortful and Mendelsohn maneuver swallows significantly alter the pharyngoesophageal pressure profile. Faster opening of the upper esophageal sphincter may facilitate bolus transfer during maneuver swallows; however, reduced proximal esophageal contractility during Mendelsohn maneuver swallows may impair bolus flow and aggravate dysphagic symptoms.

Keywords: Mendelsohn maneuver; effortful swallowing; high-resolution impedance manometry; impedance; pressure; swallowing.

MeSH terms

  • Adult
  • Biomechanical Phenomena
  • Deglutition / physiology*
  • Deglutition Disorders / physiopathology*
  • Deglutition Disorders / rehabilitation*
  • Electromyography
  • Esophageal Sphincter, Upper / physiology*
  • Female
  • Healthy Volunteers
  • Humans
  • Male
  • Manometry
  • Muscle Contraction / physiology*
  • Pharynx / physiology*
  • Pressure