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Deglutitive Subglottic Air Pressure and Respiratory System Recoil

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Abstract

The purpose of this experiment was to confirm the presence of positive subglottic air pressure during swallowing, known as deglutitive subglottic air pressure (DPsub), in a group of healthy individuals. We also sought to determine if respiratory system recoil is responsible for generating the pressure. Ten healthy volunteers underwent direct DPsub measurement via percutaneous puncture of the cricothyroid membrane. Simultaneous DPsub and nasal airflow volumes were recorded while participants swallowed calibrated boluses over a wide range of lung volumes. Body plethysmography was used to determine functional residual capacity and residual volume. A custom respiratory recoil measurement system was used to measure recoil pressures. Regression analysis of lung volume on DPsub and lung volume on recoil pressure yielded strong linear relationships (P < 0.0001, R 2 = 0.71 and P < 0.0001, R 2 = 0.69, respectively). A mixed-model analysis of the effect of method (direct puncture or recoil) on pressure showed that there was no effect (F = 0.63; P = 0.43). By confirming the presence of DPsub in healthy adults and showing that respiratory system recoil is the most likely mechanism that generates DPsub, treatment of persons with dysphagia has even greater potential to be expanded to include consideration of factors that affect respiratory control and recoil forces.

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Acknowledgments

The authors acknowledge Marike Vuga, PhD, for statistical support. This investigation was supported by the UPMC Competitive Medical Research Fund and the Parkinson Foundation of Western Pennsylvania. Sheryl Ross, MA, CCC/SLP for assisting with data collection.

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Authors and Affiliations

  1. Department of Otolaryngology, Eye and Ear Institute, School of Medicine, University of Pittsburgh, 200 Lothrop St., Pittsburgh, PA, 15213, USA

    Roxann Diez Gross, Ricardo L. Carrau, Ronit G. Gisser & Libby J. Smith

  2. Division of Pulmonary, Allergy and CCM, UPMC Comprehensive Lung Center, School of Medicine, University of Pittsburgh, 3601 Fifth Ave., 4th Floor, Pittsburgh, PA, 15213, USA

    William A. Slivka & Frank C. Sciurba

  3. Craniofacial Center, University of North Carolina, Chapel Hill, NC, 27599, USA

    David J. Zajac

  4. The Children’s Institute of Pittsburgh, 1405 Shady Ave, Pittsburgh, PA, 15217, USA

    Roxann Diez Gross

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  1. Roxann Diez Gross
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  2. Ricardo L. Carrau
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  3. William A. Slivka
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  4. Ronit G. Gisser
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Correspondence to Roxann Diez Gross.

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Gross, R.D., Carrau, R.L., Slivka, W.A. et al. Deglutitive Subglottic Air Pressure and Respiratory System Recoil. Dysphagia 27, 452–459 (2012). https://doi.org/10.1007/s00455-011-9389-2

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  • DOI: https://doi.org/10.1007/s00455-011-9389-2

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