Evaluating the tongue-hold maneuver using high-resolution manometry and electromyography

Abstract

The tongue-hold maneuver is a widely used clinical technique designed to increase posterior pharyngeal wall movement in individuals with dysphagia. It is hypothesized that the tongue-hold maneuver results in increased contraction of the superior pharyngeal constrictor. However, an electromyographic study of the pharynx and tongue during the tongue-hold is still needed to understand whether and how swallow muscle activity and pressure may change with this maneuver. We tested eight healthy young participants using simultaneous intramuscular electromyography with high-resolution manometry during three task conditions including (a) saliva swallow without maneuver, (b) saliva swallow with the tongue tip at the lip, and (c) saliva swallow during the tongue-hold maneuver. We tested the hypothesis that tongue and pharyngeal muscle activity would increase during the experimental tasks, but that pharyngeal pressure would remain relatively unchanged. We found that the pre-swallow magnitude of tongue, pharyngeal constrictor, and cricopharyngeus muscle activity increased. During the swallow, the magnitude and duration of tongue and pharyngeal constrictor muscle activity each increased. However, manometric pressures and durations remained unchanged. These results suggest that increased superior pharyngeal constrictor activity may serve to maintain relatively stable pharyngeal pressures in the absence of posterior tongue movement. Thus, the tongue-hold maneuver may be a relatively simple but robust example of how the medullary swallow center is equipped to dynamically coordinate actions between tongue and pharynx. Our findings emphasize the need for combined modality swallow assessment to include high-resolution manometry and intramuscular electromyography to evaluate the potential benefit of the tongue-hold maneuver for clinical populations.

Fig. 1

Tongue position during swallow. No maneuver (a), tongue tip at lower lip (b), tongue-hold maneuver (c)

Fig. 2

Tongue tip position from lip. Tongue tip at lip: The tongue tip was zero centimeters from the lower lip. Tongue-hold maneuver: The tongue tip was protruded about 1–2 cm from the lower lip

Fig. 3

Submental electromyography (EMG). No maneuver (gray), tongue tip at lip (white), and tongue-hold maneuver (black). Note the task-related increase in EMG amplitude at baseline (before solid line), during the swallow (starting at solid line), and after the return to baseline (starting at first dashed line for gray, and at second dashed line for white and black)

Fig. 4

Electromyographic (EMG) Data. Pre-Swallow EMG amplitude (a), Swallow EMG amplitude (b), and Swallow duration (c) for genioglossus (GG), submental (SM), superior pharyngeal constrictor (SPC), and cricopharyngeus (CP) muscles. Bar height represents the mean (standard error). *p < 0.05, ns not significant compared with no maneuver (within the same muscle)

Fig. 5

Manometric Pressure Data. Pre-Swallow pressure amplitude (a), Swallow pressure amplitude (b), and Swallow duration (c) for pressure sensors located within the pharynx at the level of the velopharynx (VP) and tongue base (TB), or within the upper esophageal sphincter (UES). Swallow related UES pressures (b) are displayed for maximum pressure immediately before the swallow (pre), immediately after the swallow (post), or for the minimum (min) pressure during the swallow. Bar height represents the mean (standard error). No significant changes were observed