Pharyngeal functional reserve (Jones & Colletti, 2021)

Purpose: Functional reserve represents the difference between an individual’s ability to produce a maximum output function and the ability to perform a functional task. Several studies have documented an age-related decrease in functional reserve with oral tongue pressure generation. Whether this pattern is seen in pharyngeal swallowing pressures is unknown. The aim of this study was to investigate pharyngeal functional reserve using high-resolution manometry during normal-effort and effortful swallows.Method: Pharyngeal high-resolution manometry was performed on 38 younger healthy individuals (≤ 40 years) and 18 older healthy individuals (≥ 60 years) during normal-effort and effortful water swallows. Pressure metrics included maximum pressure in the velopharynx, tongue base, and hypopharynx, as well as pharyngeal contractile integral and minimum pressure in the upper esophageal sphincter (UES). Repeated-measures analysis of variance was used to determine the effects of swallow task, age, and pharyngeal region on pressure generation.Results: Maximum pharyngeal pressures and pharyngeal contractile integral were significantly increased during the effortful swallows compared to normal-effort swallows (p < .001), but there were no interactions between task and age in pharyngeal pressures. In the UES, minimum pressures were significantly elevated in older individuals during effortful swallows compared to normal-effort swallows (p = .007) but did not follow a pattern consistent with reduced functional reserve.Conclusions: Healthy individuals increase pharyngeal driving pressures during effortful swallows, without an age-related reduction in the magnitude of pressure increase. Thus, this study did not find evidence for an age-related reduction in pharyngeal functional reserve. The preserved ability to increase pharyngeal pressures during effortful swallowing in aging may support the use of behavioral swallowing interventions in older individuals without neuromuscular conditions.Supplemental Material S1. Descriptive statistics for pharyngeal swallowing pressures in younger and older participants during normal effort and effortful swallows.Supplemental Material S2. Comparative statistics for repeated-measures ANOVA evaluating impact of task, age, and pharyngeal region on pharyngeal maximum pressures. Supplemental Material S3. Comparative statistics for repeated-measures ANOVA evaluating impact of task and age on pharyngeal contractile integral. Supplemental Material S4. Comparative statistics for repeated-measures ANOVA evaluating impact of task and age on upper esophageal sphincter minimum pressure. Jones, C. A., & Colletti, C. M. (2021). Age-related functional reserve decline is not seen in pharyngeal swallowing pressures. Journal of Speech, Language, and Hearing Research. Advance online publication. https://doi.org/10.1044/2021_JSLHR-21-00164

目的：功能储备代表个体产生最大输出功能的能力与执行功能任务的能力之间的差异。多项研究记录了随着年龄增长，口腔舌压生成功能储备的下降。然而，这一模式是否在咽部吞咽压力中出现尚不明确。本研究旨在通过高分辨率测压法，在正常努力和用力吞咽过程中探究咽部功能储备。方法：对38名年轻健康个体（≤40岁）和18名老年健康个体（≥60岁）在正常努力和用力吞咽清水时进行了咽部高分辨率测压。压力指标包括软腭、舌基和下咽部的最大压力，以及咽部收缩积分和上食管括约肌（UES）的最小压力。使用重复测量方差分析来确定吞咽任务、年龄和咽部区域对压力生成的影响。结果：与正常努力吞咽相比，用力吞咽时的最大咽部压力和咽部收缩积分显著增加（p < .001），但在咽部压力方面没有发现任务与年龄之间的相互作用。在上食管括约肌中，与正常努力吞咽相比，老年人在用力吞咽时的最小压力显著升高（p = .007），但并未呈现出与功能储备减少一致的规律。结论：健康个体在用力吞咽时增加咽部驱动压力，而不会出现与年龄相关的压力增加幅度减少。因此，本研究未发现咽部功能储备与年龄相关的减少证据。老年人在用力吞咽时保持咽部压力增加的能力，可能支持在无神经肌肉疾病的情况下，对老年人使用行为吞咽干预措施。补充材料S1：年轻和老年参与者在正常努力和用力吞咽过程中的咽部吞咽压力描述性统计。补充材料S2：重复测量方差分析比较任务、年龄和咽部区域对咽部最大压力的影响。补充材料S3：重复测量方差分析比较任务和年龄对咽部收缩积分的影响。补充材料S4：重复测量方差分析比较任务和年龄对上食管括约肌最小压力的影响。Jones, C. A. & Colletti, C. M. (2021). 咽部吞咽压力中未观察到与年龄相关的功能储备下降。言语、语言和听力研究杂志。在线预发表。https://doi.org/10.1044/2021_JSLHR-21-00164