Timing of events in normal swallowing: A videofluoroscopic study

Dynamic videofluoroscopic swallow studies were performed on 60 normal adult volunteers to establish normative data for clinically useful timing measur es. The relation of swallowing gesture timing to the timing of actual bolus transit was of particular interest because it provides insight into the ph ysiology of larger bolus volume accommodation. Parameters evaluated include the timing of bolus pharyngeal transit, soft palate elevation, aryepiglott ic fold elevation and supraglottic closure, arrival of the bolus in the val lecula, hyoid bone displacement onset and duration, arrival of the bolus at the pharyngoesophageal sphincter, maximum pharangeal constriction, and pha ryngoesophageal sphincter opening. These parameters represent events requir ed for normal deglutition, can be used to identify abnormalities in dysphag ic patients, and provide a basis for comparison of swallowing performance b oth within and between patients. in addition, our experience has shown them to be reliably obtained. Other investigators have reported some of the mea surements. However, to our knowledge, normative data for timing of aryepigl ottic fold elevation, soft palate elevation and closure, and maximum pharyn geal constriction have not been described. Other measures included in the p resent study may provide alternatives when conventional measures cannot be obtained in selected patients. The relevance and clinical utility of new an d alternative measures, in particular, are discussed.