This strategy is used in patients with reduced closure of the airway entrance. The effort involved in the super-supraglottic swallow increases the anterior tilt of the arytenoid and the false vocal cord closure to close the entrance to the airway early, before and during the swallow. The patient is given the instructions to "Inhale and hold your breath very tightly, bearing down. Keep holding your breath and bearing down as you swallow. Cough when you are finished