Mastering Vacuum Swallowing to Improve Pharyngeal Bolus Passage by Creating Negative Pressure in the Esophagus

Abstract

Abstract Objective Vacuum swallowing improves pharyngeal bolus passage by creating negative pressure in the esophagus. This study aimed to (1) assess whether patients with dysphagia with lateral medullary syndrome (LMS) could reproduce vacuum swallowing and (2) evaluate its safety using a swallowing and breathing monitoring system (SBMS). Methods Two patients with dysphagia with LMS were instructed to perform vacuum swallowing. Videofluoroscopic examination of swallowing (VF) was performed. High-resolution manometry (HRM) parameters, including the esophageal minimum pressure (Pmin) and maximum pressure (Pmax) in the lower esophageal sphincter (LES), were compared to the values obtained during normal swallowing. The coordination between vacuum swallowing and breathing was evaluated using SBMS. Results VF showed that pharyngeal residues in the pyriform sinus were sucked into the esophagus during vacuum swallowing. No aspiration was observed. Pmin was significantly lower, and Pmax was significantly higher during vacuum swallowing. In the SBMS study, vacuum swallowing followed an expiratory swallowing pattern; this pattern was observed in 3 out of 5 swallowing episodes in Patient 1 and all swallowing episodes in Patient 2. Deglutition apnea was observed during vacuum swallowing. Conclusion Patients could safely master vacuum swallowing. This may be a new method for improving pharyngeal bolus passage.