Modulation of swallowing behaviour by olfactory and gustatory stimulation
Thesis DisciplineSpeech and Language Sciences
Degree GrantorUniversity of Canterbury
Degree NameDoctor of Philosophy
Swallowing impairment or dysphagia can be a consequence of several neurological and anatomical disorders such as stroke, Parkinson’s diseases, and head and neck cancer. Management of patients with dysphagia often involves diet modification, sensory stimulation, and exercise programme with the primary goal being safe swallowing to maintain nutrition.
The aim of this project was to evaluate the effects of lemon odour and tastant on swallowing behaviour in healthy young adults. Specifically, the neural excitability and biomechanical characteristics of swallowing were measured in two studies. Neural excitability was evaluated by measuring motor-evoked potentials (MEPs) from the submental muscles which were evoked by transcranial magnetic stimulation (TMS) of the motor cortex. Biomechanical characteristics were evaluated through measures of submental muscle contraction, pressure changes in the oral cavity and pharynx, and the dynamics of the upper oesophageal sphincter (UES).
Two groups of volunteers (16 in each group) participated in two separate studies. In the MEP study, 25% and 100% concentrations of lemon concentrate were presented separately as olfactory and gustatory stimuli. The four stimuli were randomly presented in four separate sessions. The olfactory stimulus was nebulized and presented via nasal cannula. Filter paper strips impregnated with the lemon concentrate placed on the tongue served as the gustatory stimulus. Tap water was used as control. TMS-evoked MEPs were measured at baseline, during control condition, during stimulation, immediately poststimulation, and at 30-, 60-, and 90-min poststimulation. Experiments were repeated using the combination of odour and tastant concentration that most significantly influenced the MEP.
The biomechanical study used (a) surface electromyography (sEMG) to record contraction of the submental muscles, (b) lingual array with pressure transducers to record glossopalatal pressures, and (c) pharyngeal manometry to record pressures in the pharynx and the UES. Similar methods of presenting the stimuli were used to randomly present the 25% and 100% concentrations of lemon odour and tastant. All data were recorded concurrently during stimulation. The concentration of odour and tastant that produced the largest submental sEMG amplitude was selected for presentation of combined stimulation. Data were then recorded during combined stimulation and at 30-, 60-, and 90-min poststimulation.
Results from the MEP study showed increased MEP amplitude at 30-, 60-, and 90-min poststimulation during swallowing compared to baseline, but only for the combined stimulation. Poststimulation results from the biomechanical study showed decreased middle glossopalatal pressure at 30 min and decreased anterior and middle glossopalatal contact duration at 60 min. No poststimulation changes were found in sEMG and pharyngeal manometry measures. During combined odour and tastant stimulation, there were increased pressure and contact duration at the anterior glossopalatal contact and decreased hypopharyngeal pressure. Generally, these changes correspond to increased efficiency of swallowing.
In conclusion, these are the first studies to have measured the effects of flavour on neural excitability and biomechanics of swallowing and the first to have shown changes in MEP and several biomechanical characteristics of swallowing following flavour stimulation. These changes were present poststimulation, suggesting mechanisms of neural plasticity that may underlie potential value in the rehabilitation of patients with dysphagia.