Supraglottic/Super

Supraglottic Swallow

Andrea Salcedo & Madeline Quiñones

MSLP-549-1
The supraglottic and super supraglottic maneuvers were first
introduced in the 1980s by Dr. Jerilyn Logemann, SLP and professor
at Northwestern University. The supraglottic and super supraglottic
maneuvers are techniques that can be applied as compensatory
strategies and indirect or direct swallowing exercises.
Compensatory
● The goal of these strategies is to target specific physiological
deficits (identified through evaluation) in order to ensure and
maintain adequate nutrition and hydration without changing the
physiology.
Indirect exercise
● These are techniques meant to improve selected aspects of
muscular control without asking the patient to swallow a bolus.
Specifically, the supraglottic swallow maneuver may be used to
reteach patients the breathing pattern during swallowing.
Direct swallowing exercise
● These are techniques that involve the patient consciously
controlling their swallow while ingesting a bolus of a specific
consistency. The patient is taught to target specific areas to
improve strength and coordination of the muscles involved.
Effect of Supraglottic and Super-supraglottic swallows on Tongue
Pressure Production against Hard Palate (Fujiwara et al, 2013)
doi:10.1007/s00455-014-9556-3
A study published in 2013 evaluated the state of tongue pressure production
during supraglottic swallow and super supraglottic swallow performed by healthy adults, and
the effects of these swallowing maneuvers on the oral stage of swallowing. The participants
were 19 healthy individuals who were asked to swallow 5 mL of water by normal wet
swallow, supraglottic swallow, and super supraglottic swallow. The duration, maximal
magnitude, and integrated value of tongue pressure during swallowing were analyzed for
this study. The duration of tongue pressure was significantly longer at the anterior-median
part of the hard palate during both supraglottic swallow and super-supraglottic swallow than
with normal. The resulting data indicates that the supraglottic and super supraglottic
maneuvers can be used, not only as a compensatory strategies to increase airway
protection, but as direct swallowing exercises to strengthen the tongue pressure produced
by contact between the tongue and the hard palate during swallowing.
The Supraglottic Swallow
The physiologic benefits of this strategy include increased airway closure by increasing arytenoid approximation and true vocal fold
closure as well as increasing upper esophageal sphincter opening during the swallow. Additionally, the airway is protected earlier in the
swallow and hyolaryngeal excursion is prolonged which may be beneficial for patients with delayed swallow initiation.
1
Instructions 2

1) Inhale and hold breath tightly

2) Take a bite of food or a sip of liquid

3) Swallow while holding breath

4) Cough after swallow 3 4

5) Swallow again

6) Breathe normally and relax

The Super Supraglottic Swallow
Apart from increasing airway closure, this technique can allow the patient to have earlier tongue base movement, higher hyoid position
at swallow onset, increased hyoid movement as well as longer bolus transit time, tongue base and pharyngeal wall contact and airway
closure.

Instructions

1) Inhale and hold breath very tightly

2) Take a bite of food or a sip of liquid

3) Bear down like when pulling up on a chair with all your strength

4) Keep bearing down and holding the breath while you swallow

5) Cough after swallow

6) Swallow again

7) Breathe normally and relax.

The effectiveness of these techniques should be assessed under
instrumental evaluation before implementing them with a patient.
Patients who may benefit from the use of these maneuvers may
be experiencing any of the following:
● Decreased laryngeal closure
● Residue in piriform sinuses
● Poor superior movement of arytenoid heads towards the
epiglottis
● Vocal fold paresis or paralysis
● Laryngeal sensory deficits
● Other conditions The performance of the maneuvers may lead to cardiovascular
changes due to the exertion of forced expiration against the
closed glottis that causes the pressure in the chest to increase.
In a 2002 study by Chaudhuri et al, investigators found
evidence that the use of these maneuvers can lead to
arrythmia. It can be contraindicated for patients who:
● have underlying breathing difficulties or shortness of
breath
● have COPD
● have emphysema
Instructions may be difficult to follow for:
● individuals with cognitive impairments
● individuals who have difficulties with muscle control
 References
American Speech-Language-Hearing Association. (n.d.). Adult Dysphagia. (Practice Portal). Retrieved November 17, 2020, from
www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia/

Carrau, R. L., Murry, T., & Howell, R. J. (2017). Nonsurgical Therapeutic Intervention for Swallowing Disorders: Direct Swallow Maneuvers. In
Comprehensive Management of Swallowing Disorders (2nd ed., pp. 341-342). San Diego, CA: Plural Publishing.

Chaudhuri, G., Hildner, C. D., Brady, S., Hutchins, B., Aliga, N., & Abadilla, E. (2002). Cardiovascular Effects of the Supraglottic and Super-
supraglottic Swallowing Maneuvers in Stroke Patients with Dysphagia. Dysphagia, 17(1), 19-23. doi:10.1007/s00455-001-0097-1

Fujiwara, S., Ono, T., Minagi, Y., Fujiu-Kurachi, M., Hori, K., Maeda, Y., . . . Bohlender, J. (2014). Effect of Supraglottic and Super-supraglottic
swallows on Tongue Pressure Production against Hard Palate. Dysphagia, 29(6), 655-662. doi:10.1007/s00455-014-9556-3

Lazarus and PhD, C., Lazarus, C., Google Scholar, & Pauloski, B. (2018, June 12). Jeri Logemann's Legacy. Retrieved November 17, 2020, from
https://leader.pubs.asha.org/doi/full/10.1044/leader.FMP.20102015.np

Murry, T., Carrau, R. L., & Chan, K. M. (2020). Swallowing Exercises. In Clinical management of swallowing disorders (4th ed., pp. 117-120). San
Diego, CA: Plural.

Srivastav, S. (2020, May 28). Valsalva Maneuver. Retrieved November 25, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK537248/

The Supraglottic Swallow - Timing is Everything...: National Foundation of Swallowing Disorders - A community for those impacted by dysphagia.
(2019, August 27). Retrieved November 17, 2020, from https://swallowingdisorderfoundation.com/the-supraglottic-swallow-timing-is-
everything/

Vose, A., Nonnenmacher, J., Singer, M., & González-Fernández, M. (2014, December 1). Dysphagia Management in Acute and Sub-acute Stroke.
Retrieved November 25, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608439/