{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:32:08Z","timestamp":1792020728712,"version":"4.4.0"},"reference-count":68,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2003,7,1]],"date-time":"2003-07-01T00:00:00Z","timestamp":1057017600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Physiology"],"published-print":{"date-parts":[[2003,7]]},"abstract":"<jats:p>During swallowing, the airway is protected from aspiration of ingested material by brief closure of the larynx and cessation of breathing. Mechanoreceptors innervated by the internal branch of the superior laryngeal nerve (ISLN) are activated by swallowing, and connect to central neurones that generate swallowing, laryngeal closure and respiratory rhythm. This study was designed to evaluate the hypothesis that the ISLN afferent signal is necessary for normal deglutition and airway protection in humans. In 21 healthy adults, we recorded submental electromyograms, videofluoroscopic images of the upper airway, oronasal airflow and respiratory inductance plethysmography. In six subjects we also recorded pressures in the hypopharynx and upper oesophagus. We analysed swallows that followed a brief infusion (4\u20135 ml) of liquid barium onto the tongue, or a sip (1\u201318 ml) from a cup. In 16 subjects, the ISLN was anaesthetised by transcutaneous injection of bupivacaine into the paraglottic compartment. Saline injections using the identical procedure were performed in six subjects. Endoscopy was used to evaluate upper airway anatomy, to confirm ISLN anaesthesia, and to visualise vocal cord movement and laryngeal closure. Comparisons of swallowing and breathing were made within subjects (anaesthetic or saline injection <jats:italic>vs<\/jats:italic>. control, i.e. no injection) and between subjects (anaesthetic injection <jats:italic>vs<\/jats:italic>. saline injection). In the non\u2010anaesthetised condition (saline injection, 174 swallows in six subjects; no injection, 522 swallows in 20 subjects), laryngeal penetration during swallowing was rare (1.4 %) and tracheal aspiration was never observed. During ISLN anaesthesia (16 subjects, 396 swallows), all subjects experienced effortful swallowing and an illusory globus sensation in the throat, and 15 subjects exhibited penetration of fluid into the larynx during swallowing. The incidence of laryngeal penetration in the anaesthetised condition was 43 % (<jats:italic>P<\/jats:italic> &lt; 0.01, compared with either saline or no injection) and of these penetrations, 56 % led to tracheal aspiration (without adverse effects). We further analysed the swallow cycle to evaluate the mechanism(s) by which fluid entered the larynx. Laryngeal penetration was not caused by premature spillage of oral fluid into the hypopharynx, delayed clearance of fluid from the hypopharynx, or excessive hypopharyngeal pressure generated by swallowing. Furthermore, there was no impairment in the ability of swallowing to halt respiratory airflow during the period of pharyngeal bolus flow. Rather, our observations suggest that loss of airway protection was due to incomplete closure of the larynx during the pharyngeal phase of swallowing. In contrast to the insufficient closure during swallowing, laryngeal closure was robust during voluntary challenges with the Valsalva, M\u00fcller and cough manoeuvres under ISLN anaesthesia. We suggest that an afferent signal arising from the ISLN receptor field is necessary for normal deglutition, especially for providing feedback to central neural circuits that facilitate laryngeal closure during swallowing. The ISLN afferent signal is not essential for initiating and sequencing the swallow cycle, for co\u2010ordinating swallowing with breathing, or for closing the larynx during voluntary manoeuvres.<\/jats:p>","DOI":"10.1113\/jphysiol.2003.039966","type":"journal-article","created":{"date-parts":[[2003,5,20]],"date-time":"2003-05-20T01:48:20Z","timestamp":1053395300000},"page":"287-304","source":"Crossref","is-referenced-by-count":148,"title":["Sensory Regulation of Swallowing and Airway Protection: A Role for the Internal Superior Laryngeal Nerve in Humans"],"prefix":"10.1113","volume":"550","author":[{"given":"Samah","family":"Jafari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca A.","family":"Prince","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Y.","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Paydarfar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2003,7]]},"reference":[{"key":"e_1_2_5_2_1","first-page":"G644","article-title":"Influence of mucosal receptors on deglutitive regulation of pharyngeal and upper esophageal sphincter function","volume":"267","author":"Ali GN","year":"1994","journal-title":"Am J Physiol"},{"key":"e_1_2_5_3_1","first-page":"323","article-title":"On the mechanism of the closure of the larynx. A preliminary communication","volume":"50","author":"Anderson TP","year":"1891","journal-title":"Proc R Soc Lond B Biol Sci"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1259\/0007-1285-25-296-406"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199709000-00018"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0034-5687(95)00050-X"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1995.79.6.2169"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1992.sp019372"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199912000-00014"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199910000-00017"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.3109\/08990229109144748"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3999(94)00104-D"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00234137"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1152\/jn.1956.19.1.44"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016487409126336"},{"key":"e_1_2_5_16_1","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1152\/jappl.1995.79.5.1567","article-title":"Superior laryngeal nerve blockade and inspiratory resistive load detection in normal subjects","volume":"79","author":"Fitzpatrick MF","year":"1995","journal-title":"J Appl Physiol"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(95)90393-3"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1977.sp012065"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7793.1999.609ae.x"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1966.00760030656012"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1991.sp018537"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/0034-5687(79)90047-1"},{"key":"e_1_2_5_23_1","first-page":"227","article-title":"Localisation et activit\u00e9 des neurones deglutiteurs bulbairs","volume":"64","author":"Jean A","year":"1972","journal-title":"J Physiol Paris"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.2001.81.2.929"},{"key":"e_1_2_5_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/0006-8993(79)90715-7"},{"key":"e_1_2_5_26_1","first-page":"146P","article-title":"Laryngeal afferent control of swallowing: anaesthesia of the internal superior laryngeal nerve causes glottic dysfunction and aspiration in humans","volume":"536","author":"Jafari S","year":"2001","journal-title":"J Physiol"},{"key":"e_1_2_5_27_1","doi-asserted-by":"publisher","DOI":"10.1053\/gast.1997.v113.pm9352847"},{"key":"e_1_2_5_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/81.3.364"},{"key":"e_1_2_5_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02414429"},{"key":"e_1_2_5_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02407117"},{"key":"e_1_2_5_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/aja.1000510206"},{"key":"e_1_2_5_32_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1933.03580060445001"},{"key":"e_1_2_5_33_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.1992.262.2.G338"},{"key":"e_1_2_5_34_1","doi-asserted-by":"publisher","DOI":"10.1044\/jshr.3803.556"},{"key":"e_1_2_5_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348949210100204"},{"key":"e_1_2_5_36_1","first-page":"1415","volume-title":"Handbook of Physiology, section 1, The Nervous System, vol. II, Motor control","author":"McCloskey DI","year":"1981"},{"key":"e_1_2_5_37_1","doi-asserted-by":"publisher","DOI":"10.2307\/2685241"},{"key":"e_1_2_5_38_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.30.4.744"},{"key":"e_1_2_5_39_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-197403000-00006"},{"key":"e_1_2_5_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-1716.1963.tb02590.x"},{"key":"e_1_2_5_41_1","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.1982.62.1.129"},{"key":"e_1_2_5_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/0014-4886(74)90033-8"},{"key":"e_1_2_5_43_1","first-page":"59","article-title":"Mechanical and physiological properties of reflex laryngeal closure","volume":"81","author":"Murakami Y","year":"1972","journal-title":"Ann Otol"},{"key":"e_1_2_5_44_1","first-page":"307","article-title":"The respiratory function of the larynx: some observations on laryngeal innervation, preliminary report","volume":"54","author":"Murtagh JA","year":"1945","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"e_1_2_5_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0006-8993(99)01151-8"},{"key":"e_1_2_5_46_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.23.1.10"},{"key":"e_1_2_5_47_1","volume-title":"The Comparative Anatomy and Physiology of the Larynx","author":"Negus VE","year":"1949"},{"key":"e_1_2_5_48_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-195310000-00003"},{"key":"e_1_2_5_49_1","first-page":"R721","article-title":"Resetting of mammalian respiratory rhythm: existence of a phase singularity","volume":"250","author":"Paydarfar D","year":"1986","journal-title":"Am J Physiol"},{"key":"e_1_2_5_50_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1995.sp020584"},{"key":"e_1_2_5_51_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajplegacy.1928.84.1.36"},{"key":"e_1_2_5_52_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1941.00660030355002"},{"key":"e_1_2_5_53_1","first-page":"109","article-title":"An experimental investigation into the functions of the eighth pair of nerves, or the glossopharyngeal, pneumogastric, and spinal accessory","volume":"134","author":"Reid J","year":"1838","journal-title":"Edinburgh Med Surg J"},{"key":"e_1_2_5_54_1","doi-asserted-by":"publisher","DOI":"10.1152\/jn.1964.27.3.464"},{"key":"e_1_2_5_55_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0185(199812)252:4<646::AID-AR15>3.0.CO;2-E"},{"key":"e_1_2_5_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/0034-5687(83)90075-0"},{"key":"e_1_2_5_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/0034-5687(85)90016-7"},{"key":"e_1_2_5_58_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1976.00780120048004"},{"key":"e_1_2_5_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(90)91078-K"},{"key":"e_1_2_5_60_1","doi-asserted-by":"publisher","DOI":"10.1002\/ca.980080202"},{"key":"e_1_2_5_61_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940211100402"},{"key":"e_1_2_5_62_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00363579"},{"key":"e_1_2_5_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/0006-8993(69)90313-8"},{"key":"e_1_2_5_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/0006-8993(72)90004-2"},{"key":"e_1_2_5_65_1","first-page":"206","article-title":"Laryngeal phonatory reflex. The effect of anesthetization of the internal branch of the superior laryngeal nerve: acoustic aspects","volume":"84","author":"Tanabe M","year":"1975","journal-title":"Ann Otol"},{"key":"e_1_2_5_66_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02233643"},{"key":"e_1_2_5_67_1","first-page":"372","article-title":"Swallowing disorders in persons with cerebrovascular accident","volume":"66","author":"Veis SL","year":"1985","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_5_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0361-9230(99)00067-2"},{"key":"e_1_2_5_69_1","first-page":"724","article-title":"New insights into the causes of postoperative aspiration following conservation surgery of the larynx","volume":"96","author":"Ward PH","year":"1977","journal-title":"Ann Otol"}],"container-title":["The Journal of Physiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1113%2Fjphysiol.2003.039966","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1113\/jphysiol.2003.039966","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1113\/jphysiol.2003.039966","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/physoc.onlinelibrary.wiley.com\/doi\/pdf\/10.1113\/jphysiol.2003.039966","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T12:07:09Z","timestamp":1693829229000},"score":1,"resource":{"primary":{"URL":"https:\/\/physoc.onlinelibrary.wiley.com\/doi\/10.1113\/jphysiol.2003.039966"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,7]]},"references-count":68,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2003,7]]}},"alternative-id":["10.1113\/jphysiol.2003.039966"],"URL":"https:\/\/doi.org\/10.1113\/jphysiol.2003.039966","archive":["Portico"],"relation":{},"ISSN":["0022-3751","1469-7793"],"issn-type":[{"value":"0022-3751","type":"print"},{"value":"1469-7793","type":"electronic"}],"subject":[],"published":{"date-parts":[[2003,7]]}}}