Behavioral Interventions Targeting Insufficient Upper Esophageal Sphincter Opening During Swallowing: A Scoping...

Area of Science:

• Swallowing physiology
• Deglutition biomechanics
• Clinical audiology and speech-language pathology

Background:

• The upper esophageal sphincter (UES) is critical for safe swallowing.
• Impaired UES opening is a common cause of dysphagia.
• Behavioral interventions aim to enhance UES function during deglutition.

Purpose of the Study:

• To systematically review available behavioral interventions targeting UES opening for swallowing.
• To identify and categorize different exercise paradigms for improving UES opening.
• To assess the evidence base and quality of studies on UES opening interventions.

Main Methods:

• Scoping review of multiple databases (MEDLINE, CINAHL, Emcare, Web of Science, SCOPUS, ProQuest).
• Inclusion criteria: behavioral interventions for UES opening, assessed with UES-specific outcomes.
• Study quality assessed using Joanna Briggs Institute and GRADE frameworks.

Main Results:

• Fifteen studies met inclusion criteria, reporting four intervention types: floor of mouth exercises (Shaker, strengthening), Mendelsohn maneuver, lingual exercises, and mixed paradigms.
• Varying success reported in improving UES opening metrics across studies.
• Nine studies included patients with dysphagia; six included healthy adults.

Conclusions:

• The evidence for behavioral interventions improving deglutitive UES opening is limited.
• Methodological limitations, small sample sizes, and inconsistent reporting hinder clinical translation.
• Further high-quality research is needed to establish effective interventions for UES opening deficits.