Super-Supraglottic Swallow Combined with Head Flexion Strengthens Laryngeal Closure

The super-supraglottic swallow (SSGS) improves laryngeal closure, and head flexion compensates for inadequate closure of the airway. These two procedures are typically utilized by speech-language pathologists for specific patient populations. This study compared the effect of the SSGS with head flexion (i.e., modified SSGS [mSSGS]) on laryngeal closure with that of usual swallowing and the SSGS in healthy individuals. Twenty-one healthy volunteers were instructed to swallow 4 ml of thin liquid barium in a sitting position during usual swallowing, SSGS, and mSSGS under X-ray fluoroscopy. The primary outcome was the distance between the epiglottis and arytenoid (DEA) at onset of the swallowing reflex. The secondary outcomes were DEA before onset of the swallowing reflex, the head flexion angle before and at onset of the swallowing reflex, and the Penetration-Aspiration Scale (PAS) score. The relative ease of performing the mSSGS compared with the SSGS was evaluated using a 7-point Likert scale. DEA at onset of the swallowing reflex was significantly shorter with mSSGS than with usual swallowing (P < 0.001) or the SSGS (P = 0.006). DEA before swallowing was also significantly shorter with the mSSGS than with usual swallowing (P < 0.001) and the SSGS (P = 0.006). PAS score was 1 in all trials. The median Likert score was 3, indicating that the SSGS was easier than the mSSGS. The findings suggest that the mSSGS maneuver enhances laryngeal closure more than the SSGS maneuver and usual swallowing.