Supraglottic (SG) and Super Supraglottic (SSG) Swallow


COPD patients that have dysphagia are more likely to have increased risk of aspiration. People with a normal swallow prevent aspiration because their vocal folds close before and during swallowing (Hirst, Sama, Carding, & Wilson, 1998). In patients that are susceptible to aspiration the SG and SSG swallow are techniques used to protect the airway from aspiration (Donzelli & Brady, 2004; Hirst et al., 1998). The technique is based on voluntary closure of the true vocal folds followed by a cough to force expiration. This clears away any material that may remain in the airway (Donzelli & Brady, 2004). The difference between the SG and SSG is the amount of effort used (Grohler & Crary, 2010; Donzelli & Brady, 2004). The increased effort of the breath hold is to ensure the vocal folds are fully adducted.

Table 1: Instructions given to patients to elicit exact technique (Donzelli & Brady, 2004, p. 209)
Breath Hold Instructions
Easy Breath Hold
“Hold your breath while I count out loud to 5"
Inhale/Easy Breath Hold
“Take a deep breath, then hold your breath while I count out loud to 5"
Hard Breath Hold
“Hold your breath very tightly, bearing down, while I count out loud to 5"

Above are instructions on what to say to elicit the appropriate breath for each technique. The easy breath hold is used in the SG swallow while the hard breath is used for the SSG swallow. The correct wording is important to make sure the appropriate swallow is elicited. For the SSG swallow to be effective the true vocal folds must be completely adducted (Donzelli & Brady, 2004). Research shows that "Inhale/ Easy Breath Hold" was the least effective because while inhaling it was discovered that patients were not closing off their vocal folds so were holding their breath in the abducted position (Donzelli & Brady, 2004; Hirst et al., 1998). If the true vocal folds are not completely adducted then aspiration can still occur.


References:

Donzelli, J., & Brady, S. (2004). The effects of breath-holding on vocal fold adduction: Implications for safe swallow. Archives of Otolaryngology - Head and Neck Surgery, 130, 208-210.

Grohler, M., & Crary, M. (2010). Dysphagia: Clinical Management in Adults and Children. Maryland Heights, MO: Mosby, Inc.
Hirst, L., Sama, A., Carding, P., & Wilson, J. (1998). Is a 'safe swallow' really safe? International Journal of Language and Communication Disorders, 33(s), 279-280.