Dysphagia
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The development of a solid-state intraluminal sphincter transducer has alleviated many of the problems associated with manometric studies of the upper esophageal sphincter (UES) and pharynx (P). We used this technology to study the effect of position (upright vs. supine) on resting UES pressures and the pressure dynamics of the UES/P complex during both wet and dry swallows in 11 normal volunteers and the effects of foods of different consistencies on the UES/P swallow dynamics in 10 normal volunteers. ⋯ Significant changes in swallow coordination were measured between upright and supine swallows of the same bolus size, between wet and dry swallows in the same position, and among foods of varying consistencies. Resting UES pressure was unchanged by position and pharyngeal contraction pressure was unchanged by bolus size or consistency.
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A 72-year-old man who contracted tetanus after a puncture wound presented with severe dysphagia in association with trismus, risus sardonicus, and nuchal rigidity. We describe his medical course and outcome, including repeated videofluoroscopic barium swallow examinations. We emphasize the value of videofluoroscopy for examining and managing dysphagia in patients with tetanus, in both the acute and chronic stages of this rare illness.